health
Baroness Primarolo Excerpts(12 years, 2 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. Before I call the first Back Bencher in the general debate, I inform Members that the time limit is going to change to 12 minutes, as the number wanting to participate has reduced. May I ask that if you do not need 12 minutes, you do not take it? That time limit will probably enable us to get everyone in in the time that we have.
Social Care (Local Sufficiency) and Identification of Carers Bill
Baroness Primarolo Excerpts(12 years, 2 months ago)
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Jacob Rees-Mogg
It is worth noting that if Labour Members were so committed to the Bill, they would have been able to get 100 Members here to support a closure motion. Alternatively, they could move a motion that would force an hon. Member to bring their speech to an end, but they have not asked to use either of those mechanisms.
Madam Deputy Speaker (Dawn Primarolo)
Order. Actually, the speech of the hon. Member for Bury North (Mr Nuttall) could be terminated only if the occupant of the Chair—myself—told him to resume his seat because of tedious repetition. Whatever hon. Members might think of his contribution, he has not got to that point. I would be grateful if we could allow the hon. Gentleman to continue his speech so that others may then participate.
Mr Nuttall
Thank you, Madam Deputy Speaker.
Let me make a further quick point about the statistics that I was citing. The largest single barrier to employment that was highlighted—by 63% of respondents—was a lack of suitable local job opportunities, so an area’s prevailing employment market is obviously pre-eminent when determining whether a carer or disabled person is able to get into the workplace.
Clauses 1 to 3 would impose a sufficiency duty. The explanatory notes state that the duty
“goes beyond the existing duties and focus of local authorities which are only on those for whom they have direct responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds. There are currently no duties on local authorities to assess or address supply of non-statutory services for individuals privately purchasing care, by encouraging the development of new services.”
The notes go on to say:
“This clause would ensure that local authorities build a complete and accurate picture of the services needed, provided and purchased in their area.”
It would have been helpful if this duty could have been road-tested somewhere on a trial basis. There could perhaps have been a pilot before the Bill was introduced.
Clause 1(2) states that in discharging the sufficiency duty a local authority must have regard to statutory guidance issued by the Secretary of State. It might be expected that such guidance would clarify the terms necessary to determine what amounts to compliance with this sufficiency duty. The explanatory notes helpfully suggest:
“Placing a strategic duty on local authorities to ensure adequate social care would mean local authorities need to assess the care available in their area looking at the supply and demand of care and the affordability, accessibility and quality of provision. They would also need to identify gaps in provision and how these will be addressed. Local authorities would work in partnership with local providers to assess how services could support disabled people and carers to work, where appropriate.”
I will skip a large part of my prepared notes because, as we have heard this morning, where there is a difference between this Bill and the Government’s Bill, the Minister will look at trying to ensure that that requirement is included in the Bill.
The explanatory notes do not tell us the likely cost for every local authority to undertake the assessments that the Bill requires, and that is one of its principal problems. We have no idea of the cost of carrying out an assessment of the social care needs of disabled people and carers in any given area, which is why I suggested that a pilot project might have given us some idea of the likely cost.
Madam Deputy Speaker (Dawn Primarolo)
Order. I have been following very closely what the hon. Gentleman has been saying for the past hour. I have been able to do that because much of it is in the House of Commons research paper on the Bill. I sincerely hope that he is not just taking quotes verbatim from that. If he is, as he knows, he will be falling foul of Standing Order No. 42. Perhaps he can therefore assure me that in continuing his remarks I will not be able to read them first in this document.
Mr Nuttall
Thank you, Madam Deputy Speaker. I have indeed been helped by the Library’s document, which is extremely useful in analysing the Bill.
I will move on, if I may. As I understand it, there is nothing to prevent local authorities from carrying out the various actions proposed by the Bill, so it might be worth asking why they are not already going down that route.
Barbara Keeley
On a point of order, Madam Deputy Speaker. Is it not now the case that the hon. Gentleman is departing too far from the Bill’s content? I do not think that a discussion of the website of the Princess Royal Trust for Carers has anything to do with this Second Reading debate.
Madam Deputy Speaker (Dawn Primarolo)
This is a matter for the Chair. There is an argument that reference to the trust’s details is relevant to the Bill. The trust is also identified clearly in the House of Commons research paper.
Although this is not on a point of order, while I am on my feet I remind the hon. Member for Bury North (Mr Nuttall) that, in principle, it is not permitted to read a speech in the Chamber. It is permissible to refer to notes and read short extracts from documents, but I think that he is stretching that widely now. He is in order and I hope that he will stay in order. I am sure that he is about to conclude to allow others to speak.
Mr Nuttall
I am about to conclude, Madam Deputy Speaker. I was not going to go into the website in detail. I pay tribute to all those who help run the Bury carers centre and the Bury Crossroads group in my constituency. Their details can be accessed through the website. They provide enormous help for carers in need of help, advice and assistance in my constituency.
As I said at the outset, the hon. Member for Worsley and Eccles South should be commended for bringing this issue to centre stage. I am sure that every hon. and right hon. Member has nothing but praise for the army of carers in this country who look after loved ones. The Bill is a genuine attempt to improve the lot of carers, but I fear that there are dangers associated with it. We have to be careful how we use scarce resources; I do not want them to be diverted away from front-line services.
The consultation period on the Government’s draft Care and Support Bill is now open until 19 October. It is a substantial draft Bill, with 83 clauses and 8 schedules. I hope that the promoters of this private Member’s Bill will take advantage of the consultation to suggest how the draft Bill could be amended and improved. The Minister has also given an undertaking my hon. Friend the Member for Banbury. I will conclude now, because I want to hear from the Front-Bench representatives and other Members, so that this can be a good, wide-ranging debate.
Barbara Keeley
I welcome what the Minister says, and it would help me and the organisations and individuals who have worked with me on the Bill if he confirmed it in writing. Opposition Members do not want a plethora of duties. The Bill, in imposing duties on local authorities, might be a little too extensive, but it contains two important points that must be taken forward. The first is to have a picture of sufficiency and not to have to do everything through freedom of information requests, which might require local authorities to go a bit further than they currently do. Secondly, although there is some wonderful practice among health professionals in identifying carers, we need to go further to ensure that health bodies understand that they must have policies in place. We need to do more than just encourage a few champions to take that forward. They are the people who will have the best picture of families and the caring situations of young carers. They are the only ones who can do it. I have wonderful practice in my constituency, as well as places where it is not happening at all and people are left to their own devices. Out of everything in the Bill, those are the two points that are important to take forward. One is—
Norman Lamb
There is a degree of overlap on the sufficiency issue. I commit to discussing with the hon. Lady whether we have the framework right in the Government draft Bill or whether it could be improved—let us have that discussion. I will seek to address in my remarks the interesting philosophical argument about how best to approach identification, but parts of her Bill go beyond the responsibilities of my Department. To be clear, I am happy to engage with other Ministers to seek to address some of the issues she raises and I will maintain a dialogue with her on that.
Health and Social Care Bill
Baroness Primarolo Excerpts(12 years, 8 months ago)
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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.
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
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—
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.
Health and Social Care Bill
Baroness Primarolo Excerpts(12 years, 8 months ago)
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Nicky Morgan
Well, 175,000 have signed the petition, but there are nigh on 60 million people in this country.
Madam Deputy Speaker (Dawn Primarolo)
Order. Mr Turner, do not shout over the Chamber. Either intervene or listen to the points that are being made. You do not have to agree with them; you just have to be quiet.
Rushanara Ali
I am sorry, but I will not be able to give way.
Those people are opposed to the Bill. They have been campaigning and have joined the 170,000 people who have signed up to oppose the Bill. They oppose it because they know that it will damage health care. This Bill will damage life chances; it will destroy the NHS.
In Tower Hamlets we had the first clinical commissioning group calling on the Government to drop the Bill, led by the respected Dr Sam Everington, who said:
“Your government has interpreted our commitment to our patients as support for the Bill. It is not.”
It is shameful that the Government carried on trying to use his name in support of the Bill. Those in the clinical commissioning group are concerned about the unnecessary bureaucracy that the changes will create and about the impact on patient care. They know that top-down reforms and restructuring will detract from their ability to care for their patients. That is what they have said. I hope that the Government will listen today, because in areas such as my constituency, where child poverty is higher than elsewhere—half the children in my constituency live in poverty—and where there is an inextricable link between poverty, health and life expectancy, it is vital that we have a health service that delivers for people on the ground. This Bill will not do that—Ministers know that, so they should do something about it. [Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. I do not need any help chairing this debate; what I need is for Members to listen. If they want to have a private conversation they can go outside and have it, and then come back in for the vote.
Rushanara Ali
Thank you, Madam Deputy Speaker.
This Bill is effectively a form of backdoor privatisation of the NHS, with up to 49% of beds going to private patients. That will hurt my constituents and ordinary people up and down the country. That is why the Government need to think again. The Bill undermines the very principle of the NHS and the inspiration behind it. It highlights the fact that we cannot trust the Conservatives—or, now, some of the Liberals—with the NHS.
Waiting times are expected to go up. Already, between May 2010 and December 2011, they increased by 9%, and that will get worse. The Government need to take these issues seriously and start listening to people. In the east end, inequality continues to be a major concern, and we need to work together to reduce it. I reiterate the shadow Health Secretary’s request that we work together on this. The Government should listen, and they should drop the Bill.
As my hon. Friends have done, I appeal to the Government to think again, to think about the people of this country and to think about the people like those in my constituency who desperately need an NHS free at the point of delivery and free for those who need it. Those people do not need the marketisation and competition that are going to damage the health service. I call on the Government to drop the Bill.
NHS Risk Register
Baroness Primarolo Excerpts(12 years, 9 months ago)
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Henry Smith (Crawley) (Con)
I am grateful to have the opportunity to take part in the debate. As I have said in the House before, every right hon. and hon. Member feels passionately about the NHS. We have legitimate disagreements about the best way forward for the national health service, but we all know that it is something that each and every one of our constituents, almost without exception, and each and every member of our families, cares about. We have all relied on our health service at one time or another. It is therefore understandable that debates about the future direction of the NHS should arouse the sort of passion articulated earlier today.
It is important in the debate to reiterate what my right hon. Friend the Secretary of State said, which has been repeated by other hon. Members—that as a result of the Health and Social Care Bill, the national health service will remain free, regardless of the ability to pay, and universally available to all citizens of this country. When we discuss improvements to the health service, it is outcomes that we need to focus on.
I believe that the biggest risk to the NHS—which, as the shadow Secretary of State has said, is one of this country’s most respected institutions—is allowing it to continue with inertia and carry on as it has done in the past. At best that is a sentimental and quaint way of looking at the future of our health service. At worst it is dishonest and dangerous for the future health care of each and every one of our constituents.
Certainly, the experience in my constituency shows that the health service desperately needs change, and that without it we risk the quality of care. In 2001 maternity services were removed from Crawley hospital, and in 2005 we lost our accident and emergency department. The risks that have been experienced since those events have increased immeasurably, but since we have started to move towards the provisions of the Health and Social Care Bill we have seen considerable improvements. Waiting times have reduced for my constituents. Local GPs and clinicians very much support the provisions of the Bill and have already joined together in a GP commissioning consortium. The elected local authorities, which are a welcome addition to local health debates, are engaged, which is great for improving future health care provision and ensuring the involvement not only of patients and clinicians but of elected councillors. Only last week I was delighted to open a new digital mammography unit at Crawley hospital and a new day unit being expanded there, so already there are improvements.
In my concluding remarks I want to talk about the inconsistency we have heard from the Labour party on the release of the risk register. As we have heard, the right hon. Member for Leigh (Andy Burnham), the former Health Secretary, and his predecessor in that job, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), rejected making the risk register available on a total of three occasions. The argument that things are now different is just nonsense; the only thing that is different is that Labour are now in opposition. They are using precious time in this place to call for the release of a risk register that, as my hon. Friend the Member for Kingswood (Chris Skidmore) has said, is now over a year old and no longer relevant, because we have moved on with—
Hugh Bayley (York Central) (Lab)
I believe that the Government should publish the risk register relating to the Health and Social Care Bill, and I wrote to the Secretary of State last year to urge him to do so. I received a reply from a junior Minister in the Lords that gave the arguments that were advanced to the Information Commissioner about why it would be dangerous, including the suggestion that civil servants would pull their punches if their risk assessments were made public. The commissioner rejected those arguments, but even after he made his decision they were still being advanced by the Government, and we heard them advanced once again in the Chamber today.
The Government have got themselves into an utterly impossible position. Dozens of constituents have written to me, and I have been told by people with very high posts in the NHS, including senior clinicians, senior mangers and professors of health policy, that the Government ought to publish the register. Underneath this all is a growing belief that the only reason the Government can possibly have for not publishing the register is that it would be politically embarrassing for them to do so. [Interruption.] The Minister shakes his head, but the hon. Member for Southport (John Pugh) drew an interesting parallel. When the former Speaker in the previous Parliament sought to overturn the Information Commissioner’s decision that the information on MPs’ expenses should be published, I tabled a motion stating that we should publish the figures for second-home allowances. This was before The Daily Telegraph exposed what it did, and, had the House published at that stage there would have been a public outcry, but there would not have been the loss of public trust in this House, which came when we were seen to be hiding the data and seeking to overturn a reasonable decision, made by the Information Commissioner, that it should be made public.
The Government have got themselves into precisely that position because if, after the tribunal, they are told that the information has to be published, the embarrassment that they know they will face, they will face, but they will face it against a background of public cynicism that would not have existed if they had published in the first place. If, however, they win their case and the information on the register is not published, the public will still believe that the Government have something to hide, so my advice to them is, “You’re in a hole, stop digging and publish.”
The Secretary of State said in his speech to the House that all the information that is relevant to the debate about the Bill is in the impact assessment so there is no need to publish the risk register. But if all that we—and the public—need to know about the Bill has already been published, the Government have nothing to lose by publishing the risk register.
If we look at the impact assessment, we see that from time to time the Government have redacted certain figures, so if one or two things, for some particular reason, had to be kept secret, they would still be able to publish 99.99% of the risk register, and they would satisfy this House and public opinion and build greater confidence.
There is public fear because there are inevitably risks to increasing competition in the provision of NHS services. Increasing competition is not in itself a bad thing. The Labour Government increased competition between acute London hospitals in coronary care and achieved better coronary care outcomes, but when we contract to private providers we inevitably create risk. I should not need to tell Government Members that risk is what private companies take, and that it is given as a justification for making profit and reward, but if risk applies to profit it can and does apply to the quality of patient care.
Several Government Members have said that they want to drive up the quality of patient care and to drive down the cost of care, but they will do so only if they publish comparable data on outcomes and cost for every supplier of service to the NHS. The Government need to commit to do that and to include it in the Bill; otherwise, members of the public will fear that the consequence of the reforms, forcing competition on the NHS, will mean that some care standards will fall, which is what happens when we have unregulated—
Mr Marcus Jones (Nuneaton) (Con)
I rise as a Member who is completely and utterly committed to, and supportive of, our NHS, and completely committed to transparency and openness in government. In that vein, I applaud the Government’s recent moves to extend transparency in the Department of Health, with probably more information being provided than ever before. There is more information on IT projects and departmental spending, to name but two of the many examples of the progress that the Department is making. A similar exercise is going on across government, which I applaud.
Although it can be a ghastly system to administer, I also fully support how the Independent Parliamentary Standards Authority expenses regime is made public. I probably will not get too many cheers for saying that, but I am completely and utterly committed to transparency.
However, we have to recognise that there are often situations in which all risk scenarios are discussed, including doomsday scenarios. We need to consider carefully whether to put all that information directly into the public domain, for fear of the panic and problems that it may cause. For example, if Members saw a copy of the Treasury’s risk register and the wrong information were put out, suggesting an increase in interest rates, growth problems, problems with the banking system and the austerity measures that may be needed in a doomsday scenario, that information would be in the public domain within seconds. It would probably mean the markets going into freefall, and we would all be rushing to the nearest cash machine to take our money out, if we had any left. No Government have released such information in the past, for obvious reasons. The doomsday scenarios that we have to consider are real risks, but they rarely occur.
There is no doubt that the risk register covering the Health and Social Care Bill will include certain such scenarios, and the Government’s approach is critical to developing policy not just on health care but across the piece. That was certainly the Labour party’s view when it was in government and when the shadow Secretary of State was in charge at the Department of Health. Under his stewardship, a very similar request to see the risk register was refused, and section 36 of the Freedom of Information Act was cited as the reason. [Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. Let us not have shouting across the Chamber. We need to hear the Member who is speaking. If other Members disagree with what is being said, that is what the debate is for.
Madam Deputy Speaker (Dawn Primarolo)
Order. There are still 17 speakers who wish to participate in this debate and we have under an hour to go. May I ask Members not necessarily to take the full five minutes if they can possibly avoid it? [Interruption.] You can all sit down while I am speaking. May I also ask those who have already spoken to observe a self-denying ordinance and not intervene? They have had their chance.
Roberta Blackman-Woods (City of Durham) (Lab)
I, like my hon. Friend the Member for Easington (Grahame M. Morris), want to begin by paying tribute to the staff of the NHS. I regularly go out with the emergency services and they do a truly amazing job on our behalf in what are becoming much more difficult circumstances. I also want to pay tribute to 38 Degrees and other campaigning organisations, including the British Medical Association and the Royal College of Nursing, for what they have done to give the public more information about these reforms. I do not think that that absolves the Government of their responsibility to publish the risk register, but it is important to put on record the work that those groups have done.
I also want to pay tribute to Anne Hutton and her husband, Neil, two of my constituents who are leading the campaign against the Health and Social Care Bill in Durham. Their street stalls in Durham marketplace are becoming legendary, and I have joined them on a number of occasions. It is clear from the people who visit the stall that the more people know about the Bill, the less they like it. That is probably why the Government will not publish the register: people do not like the opening up of more of the NHS to the private sector, they are worried about fragmentation not only in commissioning but in delivery, and they want answers from the Government that they are clearly not giving.
The second issue that people raise is that they simply cannot understand why the Government are wasting money on a top-down reorganisation of the health service when we are living in such difficult economic times and the NHS is being starved of the resources it needs to meet need locally.
The third issue is that there is absolutely no mandate for either political party in the coalition to undertake such a reorganisation. Unlike those on the Government Front Bench, I have been out and about, talking to people about the reforms. That has included attending consultation events held by shadow GP consortia. The lack of information on the risk of moving to new commissioning arrangements has been a key feature of these discussions, however, as has been the likely negative impact on health outcomes of the fragmentation of services. People are getting increasingly angry that they are being asked to give an opinion on GP consortia and new commissioning arrangements without having access to information that will help them make an informed decision.
It will not have gone unnoticed by my constituents—many have written to me, just as many have written to other hon. Members—that Ministers on the Government Front Bench have today sought only to rubbish Labour’s excellent record on the NHS, rather than explaining why they will not publish the register. I am sorry that the hon. Member for Winchester (Steve Brine) is not in his place, because I wanted to take him to task. I think he insulted those of my constituents who have written to me by saying that they were simply jumping on a bandwagon. Many of them have real concerns about the Bill. Those concerns should be addressed, rather than the people who write to MPs being rubbished.
I am pleased that the parties in government have raised the issue of Labour’s record, which I shall address in the short time remaining. We are proud of our record. We employed about 90,000 additional nurses and 40,000 extra doctors, and we built more than 100 additional hospitals. That is a good record. In my area we have a new hospital. In 2006, 94% of people were having their operations done in less than 13 weeks, but that waiting time is going up, with 90% now having them done in 18 weeks. Unfortunately, all that very necessary input into the NHS did not reduce health inequalities enough, but we did hit the target for the north-east of reducing health inequalities by 10%. I am really concerned that by not publishing the register we simply will not know how these reforms will exacerbate health inequalities.
Priti Patel (Witham) (Con)
Having listened to the majority of this afternoon’s debate, I wish to start by paying tribute to my right hon. Friend the Secretary of State and his team for putting the interests of patients over the vested interests that we have heard continually try to vilify him this afternoon and over the past few weeks.
Many of my constituents have been concerned about the irresponsible spin being peddled day in, day out by Opposition Members and opponents of the Health and Social Care Bill. Frankly, they have become frightened by the rumours, rhetoric and misinformation emanating from Opposition Front Benchers. One constituent forwarded to me an e-mail, circulated by an NHS trust, that had been authored by the shadow Secretary of State. It referred to “our battle to save the NHS” and called on NHS workers to support Labour’s campaign to drop the Bill and stop the “Americanisation” of the NHS. By sending out such a provocative e-mail, he is attempting to demean my constituents and insult their intelligence. The Opposition’s motion refers to informing parliamentary debate—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. The hon. Member for Broxtowe (Anna Soubry) has been told about shouting across the Chamber by Mr Speaker. Will she please stop doing it?
Priti Patel
Those misleading comments from the shadow Secretary of State do nothing to add credibility to the wider debate or the Opposition position. Let us not forget that they went into the general election with a commitment to cut the NHS budget.
The need for this Bill is nowhere more evident than it is in Witham town in the heart of my constituency. Witham has a chronic lack of health care provision, which leaves my constituents with no choice but to travel to either Chelmsford or Colchester for the many treatments they need. That is why the local town council, including Labour and Conservative councillors, and local residents are campaigning for better local services. That is at the heart of the Health and Social Care Bill and will emanate from it—[Interruption.] Opposition Members laugh and sneer, but my constituents have been affected disproportionately by the way the previous Government maladministrated the NHS.
What is more, because of the efforts of local primary care trusts, bureaucracy and red tape has taken money from the front-line care that my constituents could have benefited from—[Interruption.] It has a lot to do with this, actually. Instead of investing in front-line health care, which is exactly what the Bill is about, the money is going to recruit bureaucrats and managers. They might be part of the wider back-room team, but I am concerned about front-line care for my constituents. My constituents might not be important to Opposition Members, but they really are important to me. This is exactly why the Bill needs to be passed. This layer of bureaucracy needs to be scrapped. There is no doubt about it.
I find it astonishing that this afternoon we have heard Labour Members preach about publishing the risk register. Let us not forget that when they ran the NHS they embarked on widespread, top-down reform on a nearly annual basis, yet they never furnished this House, Parliament or the public with confidential risk registers, analysis or data produced by Ministers and officials, so how genuine and sincere are they? If Labour Members were sincere about the NHS, they would stop their scaremongering and misinformation and recognise that the Bill is about patients’ interests and putting patients first, not their own personal vested interests.
Manufacturing
Baroness Primarolo Excerpts(13 years ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. I am keen to make sure that every Member who has indicated a wish to speak in this debate—
Madam Deputy Speaker (Dawn Primarolo)
You may sit down, Mr White, as I will not forget you and you do need to know this before you start speaking. I am going to change the time limit, because if we have 10-minute speeches, we will not get everybody in. I am therefore reducing the time limit to eight minutes per Back Bencher from you onwards, Mr White. However, you have the great joy of being called next, so the Floor is yours.
Health and Social Care (Re-committed) Bill
Baroness Primarolo Excerpts(13 years, 2 months ago)
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Paul Burstow
My hon. Friend is making some important points, which give me the chance to underscore the important points that I have made. The Bill retains for the Secretary of State the capacity to intervene and exercise the functions of all the bodies established by it, and—in extremis, as a last resort—to make sure that services are provided. It is clear that that capacity has remained, not least in regard to the Secretary of State’s ability to establish special health authorities.
My hon. Friend is asking for back-stops, and back-stops have to be real and have effect. That is why we put them into the Bill as we have, so that the Secretary of State does have, in extremis—in the circumstances that concern my hon. Friend and others—the ability to take the steps necessary to secure and ensure that services are provided to ensure a comprehensive health service.
Madam Deputy Speaker (Dawn Primarolo)
Order. May I gently remind the Minister of two things? First, he has to address the whole House. Secondly, it is not a private conversation between him and his hon. Friend, and his interventions are supposed to be brief. A lot of people are waiting to speak.
Andrew George
On that basis, Madam Deputy Speaker, I will end that part of the conversation and move on, acknowledging that my hon. Friend has made a point that is worth considering.
Amendment 1224 would restore the duty to provide or secure provision of health services. Although that is seen as the headline proposal, it is consequential on new clauses 16 and 17, hence my intention to draw attention to the likelihood of my seeking to divide the House on those issues.
Amendments 1222 and 1223 seek to establish why the Bill has never provided for the Secretary of State to provide or secure a comprehensive health service rather than promote a comprehensive health service. This is an either/or situation, but I draw attention to the possibility that instead of pressing new clause 16, I may, in discussion with others, seek to divide the House on amendment 1222.
Amendment 1183 would beef up a duty of the Secretary of State—a theme that runs through a number of amendments. The purpose of amendments 1183 and 1194 is to address the conflict between having regard to reducing inequalities and placing above that duty the other duties that apply—for example, on choice. Amendment 1183 seeks to ensure that it is the duty of the Secretary of State, in reducing inequalities, to
“act with a view to”
rather than merely “have regard to”. Otherwise, the responsibility, and the duty, on the Secretary of State is rather weak. That applies to amendment 1194 in the same manner.
New clause 18 would impose a new duty on the CQC, the NHS Commissioning Board and clinical commissioning groups not to undermine existing NHS services in an unplanned way through the operation of competition. Rather than extending my description of this issue, it might be worth referring to the debate that we had yesterday about the regulations surrounding the functions and duties of Monitor, as the same question arises. We have to look at the impact that competition is likely to have on the provision of essential services such as major trauma and accident and emergency, where its existence may destabilise emergency services through the loss of, for example, important underpinning elective services provided by the hospital.
New clause 20 would ban the wholesale outsourcing of commissioning work with regard to clinical commissioning groups. That was demanded in a Liberal Democrat conference motion but has still not been delivered. The commissioning process is a public function, not a private function. The amendment therefore seeks to change schedule 2 in different ways to prevent private entities on clinical commissioning group committees and sub-committees from commissioning and making other decisions. This also applies to amendments 1224, 1245, 1244 and 1249.
The Minister said that the work of the Neurological Alliance is important to preserve. I hope he will recognise that new clause 20 talks only about commissioning work being
“predominantly retained as a function by staff directly employed by the clinical commissioning group.”
There is nothing in the Bill that prevents the bulk of the commissioning work—not the decision, but the work—of a clinical commissioning group from being done by a private company and thus, potentially, in secret. I hope he will accept that under the current wording of schedule 2, private entities will be able to sit on clinical commissioning committees and sub-committees and make commissioning decisions.
Amendments 1184 to 1188 and 1195 would demote choice to a subsidiary duty of commissioners to tackle fair access and inequality of outcomes. They relate to page 17 of the Bill. The priority of choice over inequity and inequality was introduced by the Government after the pause and the NHS Future Forum report as a way of promoting competition in ways other than through the role of Monitor. The amendments would reverse that priority for the NHS commissioning board.
Amendment 1211 provides that clinical commissioning groups should be more coterminous with local authorities than is the case under the Bill. The Minister said that there is no intention that clinical commissioning group boundaries will cross local authority boundaries. However, we all know that district councils do not cross local authority boundaries. In Cornwall, for example, we are likely to move from one PCT to three clinical commissioning groups, which will make the streamlining of the pathways between health and social care a lot more difficult. The purpose of amendment 1211 is to enforce that point.
I am aware of time and I hope that the House will appreciate that I will not explain every aspect of the many other amendments I have tabled. I am aware that there are significant issues that other people wish to raise. I simply emphasise that what the Minister said about health and wellbeing boards being able to refer matters to the Secretary of State is once again something that we have always argued for. Local authorities should of course be given a far greater say in commissioning decisions and in setting the strategy for health services in their area. As a back-stop, it is important that matters can be referred to the Secretary of State. My hon. Friend the Member for Cheltenham (Martin Horwood) has tabled some important amendments in respect of public health, some of which I have supported, and I hope that the Minister will consider them. I apologise for the amount of time I have taken, but I hope that the Minister will address the important issues advanced by the amendments.
Rushanara Ali
The Secretary of State has spoken for long enough—[Interruption.] He has spoken, but there has not been much content—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. The hon. Lady is entitled to make her speech and to be heard in this Chamber. As all Members know, this debate ends at 6 o’clock and there are still quite a few Members who have been present all the time who wish to speak.
Rushanara Ali
Thank you, Madam Deputy Speaker.
Amendment 1169 would be of great benefit in tackling health inequalities. It would make a real difference to people’s lives. Requiring the Secretary of State to lay an annual report before Parliament on progress towards ending health inequalities is therefore key in ensuring that proper accountability continues to exist. What is he afraid of? He could see the impact and put in place mechanisms to continue to improve, learning from the evidence and making progress. Considering how we can reduce inequalities in constituencies such as mine is a constructive way forward. I call on the Secretary of State to think again and accept this sensible amendment.
In conclusion, as the Marmot review stated, the
“link between social conditions and health is not a footnote to the ‘real’ concerns with health…it should become the main focus.”
Tackling health inequalities should be a central aim of health care policy for any Government, and the amendment would be crucial for achieving that. I hope that Members on both sides will back it and that the Secretary of State will take note.
Health and Social Care (Re-committed) Bill
Baroness Primarolo Excerpts(13 years, 2 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. If the hon. Gentleman will resume his seat, let me say that the knife comes down at 8.30 pm and I would like the opportunity to give the Secretary of State five minutes at the end of this debate. I would therefore be grateful if the hon. Gentleman would watch the clock and bear that in mind.
Andrew George
No pressure, then. I will be as brief as I can. I tabled nine of the amendments in this group, and I had hoped to spend a little more time on them than I have been given this evening. I accept new clause 2, which I shall be supporting; the purpose of that proposal is primarily to rearrange the deckchairs on the Titanic, so that they do not get in the way of the lifeboats. I am happy to support new clause 2, although I have already made clear my views on the Bill and the general direction of the Government’s policy. I am not persuaded by many aspects of the Bill; indeed, I am very unhappy about them. I was very persuaded by the coalition agreement and felt that the balance of policy proposals in it was pretty much right. There were a number of debating points about the role and dynamics of “any willing provider”, but apart from that the themes were absolutely right. However, they were not reflected in the White Paper.
That said, the purpose of my amendments—the right hon. Member for Holborn and St Pancras (Frank Dobson) articulated this point far better, I am sure, than I am about to—is primarily to ensure that Monitor’s role to ensure that anti-competitive behaviour is kept in its box is balanced by looking at the impact of competitive behaviour that might undermine the ability of NHS services to collaborate.
The underlying purpose of amendments 1207 and 1208 is to neutralise or balance the new duty on Monitor to prevent anti-competitive practices that are against the interests of the people who use the services—in other words, patients—by also applying a duty to prevent anti-collaborative practices that would have the same effect. The Government say that that would result in Monitor preventing all practices that were against the interests of patients, but I disagree. Some unsafe practices would be neither competitive nor anti-competitive. The amendments would result in there no longer being a focus mainly on dealing with anti-competitive practices. I believe that that would strengthen the role of the regulator. This is a question of putting competition in its box, and it is important to ensure that it is put properly in its box, properly defined, and that the lid is put on. The purpose of the amendments is to achieve that outcome.
The Secretary of State told me, in response to an intervention relating to amendments seeking to secure a far better ability for Monitor to regulate the integration of services, that it should not be Monitor’s role simply to sustain services that are presumably otherwise unsustainable. The problem with that, in relation to my amendments 1205, 1209, 1229 and others, is that we need to ensure that we sustain the essential services. The important point here, which others have articulated, is that certain services clearly need to integrate. An example is acute emergency trauma centres. If the orthopaedic, paediatric or ophthalmology services were removed from such essential centres, their ability to deal with a wide range of emergencies would be fundamentally undermined. They serve populations of between 250,000 and 500,000 people—sometimes more—and they are absolutely essential. We must ensure that we do not end up with a regulator that allows them to be undermined by imposing a duty on them not to act in an anti-competitive manner.
The purpose of the amendments is to probe these issues, but the Government have made it clear that the NHS will no longer be the preferred provider, which leaves a question mark over the future of those essential and acute services. I will sit down now in order to give the Secretary of State more time than you requested for him, Madam Deputy Speaker, but I want to emphasise that I shall support the Government’s new clause. My amendments are probing amendments, but I wish that we had more time to debate these issues. This is very frustrating.
Madam Deputy Speaker
Order. I just remind the hon. Gentleman that the timetable for the debate was not set by me. I am merely assisting the House to meet its deadlines.
Mr Lansley
I am grateful to my hon. Friend the Member for St Ives (Andrew George) for the additional time, and I appreciate what he said in his speech. On securing continuing access to essential services, we are in exactly the same place. If a service is essential, it will be the responsibility—and, indeed, the objective—of the commissioners of that service to make it clear that they expect the regulator, or the administrator on the regulator’s behalf, to secure access to those services.
That was one of the three points that the hon. Member for Leicester West (Liz Kendall) mentioned. I thought that she made rather a good speech, but its basic premises were flawed. She also said that Monitor would be responsible for making decisions on what happened to services in the event of a failing or failed provider, but that is simply not true. The whole point of this group of amendments, including new clause 6 and amendments 198 and 199, is to make it clear that commissioners will lead in those circumstances. The proposed structure in the event of failure, through the administrator and the regulator, must be led and approved by the commissioners, who will be clinically led. The fact that the hon. Lady can look at the consultation with, for example, clinical advisors and clinical senates, does not preclude the fact that it will be local clinicians leading the process. Nor does it preclude the fact that local authorities will have an opportunity to intervene, through the scrutiny powers that the amendments will bring in. Indeed, even the Secretary of State will have the opportunity to intervene. It will not simply be a matter of Monitor doing this; the process will be led by commissioners and clinicians, and local people will have the opportunity to intervene.
The hon. Lady also mentioned competition. The Labour party seems somehow to have turned against competition, in a complete shift from where it was in 2006. My hon. Friend the Member for Southport (John Pugh) said that we were bringing in Blairite health reforms-plus, but I think that we are doing something altogether more coherent, purposeful and positive. I would far rather that the comparison involved the focus on quality that the noble Lord Darzi brought in when he was a Health Minister. In so far as Mr Blair pursued these objectives when he was Prime Minister, I think that we are doing it much better.
The amendments, and the Bill, will not allow discrimination in favour of the private sector in the way that the last Labour Government did. We are going to stop that. We are going to stop cherry-picking, because variation in price could not be by virtue of the specific characteristics of the provider. Clause 58(10) makes it clear that Monitor cannot discriminate in favour of the private sector. When the hon. Lady’s predecessor as Member for Leicester West, a previous Secretary of State, set a target for the private sector’s proportion of activity in the NHS, she was wrong. We are not going to do that. The only objective is to secure providers that deliver the best quality for patients. That is what we are all about.
I am grateful to other colleagues for their contributions to the debate, to which I cannot do justice. My hon. Friend the Member for Boston and Skegness (Mark Simmonds) asked whether commissioners would lead improvements in quality. The commissioning board will sort out disagreements, monitoring the commissioners, and together they must draw up plans to deal with providers that have failed.
My hon. Friend the Member for Southport asked whether Monitor or the Office of Fair Trading would deal with mergers. If we were to decide that it should be Monitor, the OFT would still have jurisdiction through its merger regime, so we would be duplicating that regime. I can assure my hon. Friend that, when the OFT is involved in any FT mergers, it will seek sectoral advice from Monitor, and that patient’s interests will always be central to the considerations during the merger.
The hon. Member for Easington (Grahame M. Morris) and other Labour Members were going on about the takeover of failing hospitals by foreign companies. Let me make it clear to them that the last Government, in the National Health Service Act 2006, enabled the franchising of an NHS trust to a private company. That is the legislation under which the last Government initiated the franchising of management at Hinchingbrooke hospital. The last Labour Government then passed legislation in the form of the Health Act 2009, which would have enabled exactly the same thing to be done for foundation trusts, following de-authorisation. Our proposals would specifically prevent that, because we prevent de-authorisation in that way and we are withdrawing the 2006 legal framework for NHS trusts, which, in the long run, of course, will cease to exist.
This group of amendments is part of ensuring that the NHS is and always will be there when we need it. Through this Bill, we will strengthen our confidence in continued access to the services patients need. By contrast, the Opposition would leave the NHS stranded; they would take it back; they are by turns reactionary and opportunist. I invite the Opposition to withdraw their amendments and, if not, I invite the House to reject them. I understand the positive intentions of my hon. Friends who have tabled amendments, but I also ask them to withdraw them. Strengthened by our continuing commitment to listen and to respond, I invite the House to agree to the Government new clauses and amendments.
Question put, That the clause be read a Second time.
The House proceeded to a Division.
Madam Deputy Speaker (Dawn Primarolo)
I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.
The Minister of State, Department of Health (Paul Burstow)
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Dawn Primarolo)
With this it will be convenient to discuss the following:
Government new clause 4—Orders under section [Duration of transitional period] that apply to only some trusts.
Government new clause 5—Repeal of sections [Duration of transitional period] and [Orders under section [Duration of transitional period] that apply to only some trusts].
Government amendments 88, 89 and 108 to 112.
Amendment 17, in clause 117, page 122, line 3, leave out subsection (12).
Government amendments 282 and 285.
Paul Burstow
These Government amendments will make important changes to extend Monitor’s intervention powers over all foundation trusts until 2016. This would give additional time for foundation trusts’ governors to build the capability that they need to be able to hold their boards to account.
As my right hon. Friend the Secretary of State has described, through part 3 of the Bill, Monitor as the sector regulator would have permanent intervention powers over all providers, including foundation trusts. These will allow it to fulfil its duty to protect and promote the patient’s interest and its functions include supporting commissioners in securing continuity of services. That is why we believe that Opposition amendment 17 is not only ineffective, based as it is on non-existent terms of authorisation, but also redundant.
My right hon. Friend the Secretary of State has already confirmed that we agree that it is essential that Monitor, as health sector regulator, can take action to secure patients’ continued access to NHS services, and our plans ensure this. Monitor would have powers under its licensing regime to require a provider to take specific actions if it gets into difficulties. These will be effective safeguards to protect patients’ and taxpayers’ interests, and will support commissioners in securing continued access to services that patients depend on for their care. I hope, therefore, that the hon. Members who tabled the amendment will not press it.
However, the NHS Future Forum raised concerns about the current readiness of foundation trust governors to take on the strengthened role that the Bill provides for them in holding foundation trusts to account as autonomous NHS providers. In response, the Government have agreed that Monitor’s intervention powers should apply to all foundation trusts until 2016, to allow time for their governance arrangements to become fully effective. The amendments provide for the transitional powers to continue until 2016. They also make corresponding amendments to clause 117 on licence conditions supporting use of the powers, and remove clause 116, about identifying which foundation trusts would be subject to the powers.
The amendments do not change the nature of the transitional intervention powers set out in clause 117. Monitor will continue to have the power to remove or suspend members of the board of directors or members of the council of governors. Monitor would also be able to direct a foundation trust to do or not to do specific things within a specified timetable. These powers are similar to those currently available to Monitor in its role as foundation trust regulator, and would allow Monitor to continue to protect the taxpayers’ interest in foundation trusts.
The powers go beyond those that Monitor would have over all providers, under part 3, as sector regulator. They will help to ensure a smooth transition from the current arrangements for NHS foundation trusts. The amendments would allow the Secretary of State to seek further parliamentary agreement to extend the powers beyond 2016 for all or some foundation trusts for up to two years at a time. That power could be used, for example, if there was a significant remaining concern about the governance of some foundation trusts.
If it were decided to extend the powers for some, but not all, foundation trusts, Monitor would be required to go through a process similar to that originally envisaged in clause 116. It would have to publish the criteria that it would use to decide which foundation trusts would remain subject to its intervention powers. Those criteria would be subject to consultation and would require approval from the Secretary of State. The amendments will ensure that the transitional regime proposed in the Bill provides a more secure safety net while foundation trust governors develop the skills and capabilities necessary to hold their boards to account.
The amendments would enable Monitor to rectify avoidable difficulties at a foundation trust while foundation trust governance arrangements developed, ahead of normal regulatory intervention through the licensing regime. They also provide for the extension of the powers, should that prove necessary. I commend them to the House.
Madam Deputy Speaker (Dawn Primarolo)
With this it will be convenient to discuss the following:
New clause 22—Private health care: rules—
‘(1) Section 44 of the National Health Service Act 2006 (Private healthcare) is amended as follows.
(2) Insert new subsection (A1) as follows—
“(A1) NHS Foundation Trusts must act in accordance with the following rules when carrying out their functions under this section—
(a) NHS Foundation Trusts are not permitted to operate NHS functions or contracts in a manner which promotes their private healthcare operation;
(b) any private healthcare service offered should only be within the provision of the services and procedures which are not also duplicated by the Trust’s NHS functions or contracts; and
(c) the Trust should at all times operate any private healthcare interest in a manner which in no way conflicts with its responsibility to provide unfettered access of its NHS patients to its NHS services.”’.
Amendment 1165, page 159, line 24, leave out clause 168.
Andrew George
The new clauses deal with a totemic issue that has bedevilled the debate throughout and raised concerns. The question whether to raise the cap or leave it where it is is a ham-fisted reaction to our current situation in the Report stage of a re-committed Bill. There should be an opportunity for further consideration, and I hope the issue will be examined in another place.
There has been much hyperbole about the privatisation of the NHS and other themes that have run through the debate. The general concern is that, as a result of various genies being let out of bottles and caps being lifted, we will end up with an NHS driven more by concern with private profit than by concern with matters of patient care. There is a slippery slope, of which that issue is symptomatic, throughout the Bill.
The purpose of the new clauses is to address that issue and retain the cap to ensure that the matter is kept under appropriate control. The rough and tumble of political debate means that we will end up scoring points off each other and asking who introduced foundation trusts and so on. We have been through that playground before and I do not intend to go in that direction, but I want to make sure that we have an opportunity to explore the matter. We do not have much time so I will not detain the House unnecessarily.
The removal of the cap will give more scope for NHS trusts to compete in the market, which will make them more likely to be considered undertakings for competition law purposes, even in respect of NHS services which the hospitals claim their private work subsidises, thus allowing competition law to reach further and more firmly into the NHS. The Government briefing does not even dispute that fact, as far as I can see. Also, if NHS foundation trusts can muscle in on the private market, rather like the BBC, private providers will feel more justified in arguing for the right to compete for far more NHS services, and the courts may well agree.
New clause 19 recognises that pay beds in the NHS represent a challenge, both ethically—it is about how beds can be reserved for paying patients in the same hospitals where poorer patients with higher needs must wait—and with regard to competition law. It would phase out the reserving of beds for paying patients in NHS hospitals by 2015.
New clause 22 would put a bar on foundation trusts offering private services where that would compete with their NHS provision. I certainly know, having undertaken surveys of the NHS 12 years ago, that the specialties with the longest waiting times—I will not say which, but Members might guess—happened to be those in which the most private practice was going on. One might argue that the private practice resulted from the long waiting times, but the long waiting times could have been part of a system that enabled the private sector to flourish. I fully accept—to save the Minister a lot of time in his response—that the new clause is technically very deficient, so I will not press it to a vote, but I want to express my concern and probe the issue in debate.
I know that there are ethical considerations here and that the General Medical Council and others would not only frown on the kind of practices I am implying might go on, but would rule against them. The concern is that the trusts, or those working for them, might be seduced into behaving in ways that drive their NHS patients into the arms of their private wings. Once we go down that road, many conundrums will arise and will need to be sorted out. I do not believe that the Government entirely have a handle on the issue, which is why I believe that simply lifting the cap, despite all the justifications they have given, needs a serious rethink.
Hospital Food
Baroness Primarolo Excerpts(13 years, 5 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
I am sorry for the interruption, but the procedure caught up with us. Please, continue.
Joan Walley
I am most grateful for the explanation, Madam Deputy Speaker. I was confused by the fact that this Adjournment debate started before 10 o’clock. That might explain some of my slight nervousness, as I was unsure about whether I was speaking in order with the proceedings of the House. I am grateful.
Sustainable food procurement links to health and to hospital food, too. I want the Government to set out the role that food plays in patient pathways and the priority I believe that hospitals should give to ensuring that, where required, patients are assisted to eat the food that is served. We have heard too many shocking accounts of malnutrition and dehydration as well as the plain criticism that hospital food is bad and unappetising. We should be doing something about that.
At the core of this debate is a central contradiction. The Government are happy to rail against regulation and boast about their bonfire of red tape, but they are equally proud—and rightly so—of their standards for the procurement of sustainable food for the Olympics and of their intentions for there to be a Government buying standard for food. They promote their localism agenda aggressively, leaving choice to those at a local level, but the net effect, I believe, is that no overall quality standard applies to the food served in hospitals. I do not see how such a postcode lottery can be justified and I want to consider that in more detail.
Let me turn first to malnutrition. It is not just a matter of having appetising food for patients; this can literally be a matter of life and death. In its 2009 report submitted to the Department of Health, the Nutrition Action Plan Delivery Board showed that in the region of 47,800 people had died with malnutrition while in English hospitals in 2007. Of those, 239 patients died directly because of malnutrition—that is an important distinction to make. In the report, the delivery board recommended as a key priority that the Government should clarify nutrition
“standards and strengthen inspection and regulation”
to address this problem. The issue is being flagged up.
In its recent report, “Still Hungry to be Heard”, Age UK found that the number of people leaving hospital malnourished is on the increase. A recent answer to a parliamentary question from my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), placed in the Library of the House of Commons, acknowledged that from 2006-07 to 2009-10, instances of malnutrition increased in total from 2,581 to 3,773 and, as regards discharged episodes, from 2,883 to 4,412. That inevitably leads to further serious consequences, including longer stays in hospital, the need to take more medication and an increased risk of infection and even death.
To put it in purely financial terms, the estimated cost of malnutrition to the NHS in 2006 was £7.3 billion a year. Although we do not have an accurate figure for how much it costs the NHS today, given the fact that malnutrition is on the increase it is likely to be higher still. I believe that the Department of Health should have up-to-date figures on the cost of malnutrition, and I urge the Minister to look into the matter and give us an indication of what the costs are.
Dealing with malnutrition in hospitals is not simply about making food taste better. Even if we could do that, a whole range of other issues must be addressed. First, hospital staff must be aware of what food patients can and cannot eat. They need to be able to identify which patients need help with eating their meals and to be willing and able to provide that help or, if they cannot provide it, to have a robust system of volunteers to assist. Age UK has produced a seven-step guide to eradicating malnutrition in hospitals, to which I urge the Minister to give his attention. There is also an issue with dehydration and it is important to make sure that patients in hospital have proper access to water. That simply cannot be taken for granted.
It is not only nutrition and malnutrition that need to be addressed. There must be recognition by Government of the role that healthy food plays in healthy lives. The Government estimate that 70,000 preventable deaths each year in the UK are caused by diet-related ill health. One simple thing that the Government could do to tackle that problem is to ensure that the food served to patients in hospital is nutritious. That sounds simple but the issue is how it will be done. It is also important that the Government prioritise the role of public health.
I also want to mention the dignity and nutrition reports—[Interruption.] I am most grateful. Talking of dehydration, it is important that I refer to the dignity and nutrition reports recently published by the Care Quality Commission.
Madam Deputy Speaker (Dawn Primarolo)
Order. If the hon. Member wishes to take a seat and take some more water so as not to strain her voice, I am sure that the Chamber will not mind waiting a few seconds more.
Joan Walley
I am most grateful Madam Deputy Speaker.
The first tranche of what will be 100 dignity and nutrition reports into individual hospitals found that in four of the 10 hospitals investigated, the nutritional needs of patients were not being met. The reports also stated that the quality of hospital food remains a long-standing concern. This highlights both the extent of the problem and the importance of the Care Quality Commission’s role in monitoring and reporting on hospital performance in relation to nutrition. I believe that its resources should be increased so that it can carry out more such checks and fulfil the delivery board’s recommendation of strengthening inspection and regulation. I also believe that the CQC should be made fully accountable for how that work is done.
I want to discuss regulation because that is ultimately the best means of improving hospital food. It is remarkable that there are still absolutely no legal standards governing the quality of the 330 million meals served in the NHS each year. In its report, “Yet more hospital food failure”, published earlier this year, Sustain’s “Good Food for Our Money” campaign surveyed dozens of Government-backed initiatives to improve the quality of hospital food. Alas, it found that those initiatives have cost at least £54 million of taxpayers money and have achieved improvements in only very few isolated cases. The reason is simple: they have all been voluntary, so except in those few isolated cases they have been largely ignored. Let us contrast that with the successful attempts to improve the food served in schools, where meals have to meet legal nutritional standards. A survey by Consensus Action on Salt and Health—CASH—in October 2010 showed that most meals served to children in hospital could not legally be served in a school because they contained too high a level of salt and saturated fat. The reason for the success in schools is simple: minimum nutritional standards in schools are legally binding, but in hospitals they are purely voluntary.
To date, successive Governments have failed to send a clear message to hospital caterers that the quality of their food is critical to patient health and the sustainability of our food system. It is not asking for the impossible. For many years, the Royal Brompton hospital in Chelsea has practised a progressive approach to its food procurement, providing nutritious and appetising meals prepared from fresh ingredients, which enables patients to recover faster.
Unfortunately, the Government’s ideological commitment not to introduce more regulation, regardless of its merit, is a serious block to improving hospital food. I return to Government buying standards. The coalition Government have at least recognised that voluntary initiatives have limited effect; they do not work across the board and over time. As a result, they will introduce Government buying standards that set compulsory minimum standards for food served in central Government institutions. I hope it will be soon, as the standards were promised for March 2011, and we have waited for more than a year. They were promised by the Conservative party pre-election; they were welcomed by the coalition Government and were the subject of a great deal of Department for Environment, Food and Rural Affairs civil servant attention throughout 2010. The work also involved the Department of Health to integrate badly needed health standards for food served in central Government institutions. The integration of health and sustainability standards for food bought with public money was an innovative and much needed approach, and should act as an inspiration for the wider catering sector to follow suit. Tackling health, ethical and environmental issues together should save the country money and be of great benefit to food producers and the environment.
The real issue for me is that even when the Cabinet Office home affairs committee signs off the Government buying standards, they will not apply to hospitals and hospital food. That is the heart of the concern. On the day the Government are revising the Health and Social Care Bill and recommitting it to further scrutiny, should the Health Minister not be exploring with colleagues at DEFRA and in the Cabinet how the long-promised Government buying standards can be extended to hospital food? If that is ruled out, surely there should be urgent discussions with the NHS Future Forum, the National Audit Office and expert groups, such as Age Concern and Sustain, which have a track record on this matter, with a view to tabling amendments to the Bill so that we have minimum standards for nutrition in hospital food.
Public Health Observatories
Baroness Primarolo Excerpts(13 years, 6 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. There are just over 10 minutes left, so is it by agreement that I call the hon. Member?
