Health and Social Care (Re-committed) Bill
Clive Efford Excerpts(14 years, 5 months ago)
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Mr Lansley
I do not recognise such a scenario and in any case there will be no transfer of NHS-owned organisations and the estate and property of such to the private sector. We are not engaging in privatisation, so to that extent the question does not arise.
I must also make it clear that the implication of the proposals I have just described—
Mr Lansley
No.
The implication of these proposals is that we are not continuing with our previous proposals to have a system of prior designation. We are also withdrawing our proposals to apply insolvency law, including the health special administration procedure, to foundation trusts, so I hope that Opposition Members will not press amendments 29 and 30.
I hope that that explanation of the purpose of the substantive group of Government amendments will help the House. In a moment, I shall turn to some of the additional amendments that have been presented by other colleagues.
NHS Future Forum
Clive Efford Excerpts(14 years, 8 months ago)
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Mr Lansley
I can assure my hon. Friend that I know his local GPs, and that they want to work with their professional colleagues across their area and to get on with that now. We will continue to be able to delegate commissioning responsibilities to all commissioning groups who are ready to do that; if they show that they are ready, we can give them the capacity to do it through existing NHS structures.
Clive Efford (Eltham) (Lab)
This is not a U-turn; it is a body-swerve around the Liberals. The Secretary of State has spent the last year telling us that cherry-picking for profit in the NHS will not be possible under his Bill, yet today’s report has told us that he must take action to prevent such cherry-picking. Does the Secretary of State understand that this is now an issue of trust, and that nobody trusts him on the NHS—made in Britain by Labour, stolen by the Tories, and given away to his fat cat friends?
Mr Lansley
I will not attempt to compete with the hon. Gentleman on any driving analogies, but we have been clear that we will not countenance cherry-picking against NHS providers. The Future Forum has made recommendations on that, but they are not all to do with the Bill: for example, the processes I described of using a tariff lie outside the scope of the Bill. The Future Forum is making recommendations, and we are responding positively to them.
Future of the NHS
Clive Efford Excerpts(14 years, 9 months ago)
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John Healey
The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.
Clive Efford (Eltham) (Lab)
Like my right hon. Friend, I heard the Prime Minister and Deputy Prime Minister over the weekend say that there will be changes to the Bill. However, every Government Member who has intervened has defended the position in the Bill. Will we see changes as a result of pausing, listening and reflecting, or not? Will the Liberal Democrats have a spine tonight and vote with the Opposition to get changes to the Bill?
John Healey
My hon. Friend puts the position and the challenge, especially to the Lib Dems, very clearly. The challenge to Conservative Members is this: they must recognise that the Prime Minister made the NHS his most personal pledge before the election. People wanted to believe him, but in just one year the NHS has become his biggest broken promise. My hon. Friend mentions the pause. In our Opposition motion in March, we urged the Government to
“pause the progress of the legislation in order to re-think their plans”.—[Official Report, 16 March 2011; Vol. 525, c. 374.]
The Health Secretary dismissed that, but he has now been told to do so by the Prime Minister.
However, many of the signs point to the Prime Minister’s “pause to listen” being a sham. Just one week after the announcement, and in fact on the day that the Health Secretary received that historic vote of no confidence at the Royal College of Nursing, the NHS chief executive wrote to NHS managers to tell them that
“we need to continue to take reasonable steps to prepare for implementation and maintain momentum on the ground”.
The House is used to pre-legislative scrutiny, but not pre-legislative implementation.
Clive Efford (Eltham) (Lab)
I must confess to being somewhat confused about where we have got to with the Bill. I have been here for 14 years and I cannot recall a Bill being halted after it had been through Committee so that we could go back and consult the public. I will be corrected by Members who have been here longer than me, but I cannot remember anything like this extraordinary situation.
Yesterday, I listened to the Deputy Prime Minister on the “Andrew Marr Show”. He said:
“Let me stress this, it’s not a gimmick, it’s not a PR exercise. We will make changes, we’ll make significant and substantive changes to the legislation”.
We have not heard any of that tonight. No one has got up and said, “We are listening,” or, “We are pausing,” or “We are reflecting and we are going to see substantial changes to this Bill.” The Secretary of State is in his place: I would like him to intervene on me and tell me that in relation to GP commissioning, the full £80 billion will be transferred to GPs, as he has frequently stated it would; that they will be in charge of commissioning and that we will not see that altered in any significant way as a result of the interventions of the Prime Minister or the Deputy Prime Minister. Members of the Government are trying to say that they are listening and that they are not responsible for all this, but I have here the White Paper that was published back in January, the foreword of which was signed by the Prime Minister, the Deputy Prime Minister and the Secretary of State for Health. They all signed up to it, but all of a sudden we are back to pausing, reflecting and listening.
What or who are we listening to? We have heard from the Secretary of State tonight that there are no cuts in the NHS, but let me tell hon. Members the story of Mrs Bell, a constituent of mine who was referred by her GP to a consultant last spring about cataract operations. She received the first operation within 18 weeks, and when she went back for a second consultation about the other eye she was referred for another operation. After 18 weeks, she rang the local health care trust to say that she had been waiting for her cataract operation for 18 weeks, but she was told that that was no longer a deliverable target. She ended up waiting more than 26 weeks for that cataract operation, so no one can tell my constituents or anyone else that we are not seeing cuts to the NHS and longer waiting times for patients.
What is fundamentally wrong with the Bill is that it places the market at the head of commissioning and planning services. The coalition document said that the coalition was going to introduce some element of democracy into primary care trusts, but PCTs got demolished as part of the proposals. My local PCT has been absolutely decimated, because although the Bill has not gone through Parliament yet, people are acting on it: they are voting with their feet and they have all gone. Currently, my area has no one who is responsible for the oversight and planning of our local health care services. Moreover, no one who will ultimately be accountable to local people is responsible for planning local services. All of that has been frittered away; it has disappeared. What we need is some form of democratisation of the commissioning process so that local people can know quite clearly who is accountable and who is not.
Tonight’s vote presents the Liberal Democrats—after we have paused and listened and reflected and after all they have said over the weekend about changes to the legislation—with an opportunity to send a message to the Government. This morning, the hon. Member for North Norfolk (Norman Lamb), the Parliamentary Private Secretary to the Deputy Prime Minister, said on the “Today” programme that there will be significant changes to the Bill. If the Liberal Democrats want to send a message to the Government, they should join the Opposition in the Lobby tonight and send the message that the Bill has to be changed. But I will tell them what will happen when it comes to Third Reading. The Whips will get to them, they will be as spineless as ever and they will go through the Lobby defending the Bill’s Third Reading—
Oral Answers to Questions
Clive Efford Excerpts(14 years, 10 months ago)
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Mr Lansley
I am glad to endorse my hon. Friend’s congratulations to the staff and team at Warwick hospital. I hope to have an opportunity to visit that hospital at some future date. Across the NHS, we are setting out not least to increase productivity and efficiency, stimulate innovation, reduce administration costs and put more decision-making responsibility into the hands of those who care for patients, which the Labour party failed to do.
Clive Efford (Eltham) (Lab)
How can the Secretary of State convince people that he is protecting front-line services when a flagship Bill such as the Health and Social Care Bill is in such disarray? While he is pausing and listening and reflecting on that Bill, will he also consider whether the House will have a further opportunity to consider his reflections, because we are through the Committee stage? Will there be another Committee?
NHS Reform
Clive Efford Excerpts(14 years, 11 months ago)
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Mr Lansley
Yes, I can. Under the coalition Government, in mid-Essex there has been a 3.2% increase in cash for the NHS this year compared with last year. Not only that, but more of that money will, as a consequence of our changes, get to the front line to deliver improving services for patients.
Clive Efford (Eltham) (Lab)
“No decisions about us without us” could apply to every single person who works in the NHS who has been telling the Secretary of State that these are reckless changes. Throughout the country changes are taking place. Now he says that he is going to be listening. If so, we can anticipate some more changes. Will he therefore instruct everyone in the NHS who is currently restructuring on the basis of the Bill to stop that restructuring until we know exactly what the Government intend to do?
Mr Lansley
No, I will not, because we are very clear about the strategy and the principles of the Bill. We are equally clear that now we have the opportunity to work with the developing GP pathfinder consortia, the health and well-being boards in local authorities and the wider community to ensure that the implementation of the Bill and its structure support those developing organisations.
NHS Reorganisation
Clive Efford Excerpts(14 years, 11 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
The Labour motion is interesting. I will ask the House to reject it, but it is an interesting motion. The first half of it accepts the principles of our reforms—it even does so in the same terms in which we have expressed them—but in the second half it goes on to say, “Not yet. Don’t make us do it yet.” Labour Members are turning their backs on the change that we need in the national health service and even on the policies they pursued in government.
But it is time for change. The public agree—65% of adults in England think that fundamental changes are needed in the national health service. The need to improve results for patients demands it. The need to empower clinical leadership demands it. The need to cut bureaucracy and invest in front-line care for patients demands it. As a coalition Government, we do not shirk our responsibilities. We have been absolutely clear that the NHS will remain free at the point of need, paid for from general taxation and based entirely on need and not on the ability to pay.
Those values are not, and never will be, threatened by this Government. The Health and Social Care Bill will not undermine any of the rights in the NHS constitution. It is for those same reasons that we, in a coalition Government, are protecting the NHS in the life of this Parliament by increasing NHS funding by £10.7 billion.
Clive Efford (Eltham) (Lab)
Will the Secretary of State distance himself from the comments of Dr Charles Alessi, a GP alleged to have been one of the architects of GP commissioning in this Bill and one of the people invited to No. 10, who is of the opinion that too many people in his area are receiving treatment for macular degeneration? Is that not rationing services and nothing whatsoever to do with providing them on the basis of clinical need?
Mr Lansley
All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.
Health and Social Care Bill
Clive Efford Excerpts(15 years, 1 month ago)
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Mr Lansley
The accountability in the NHS will be for the quality of the service being provided. The hon. Gentleman may not have agreed with the last Labour Government on this, and perhaps many in the Labour party are now changing their view on what was pursued by that Government, but it was that Government who introduced and encouraged a policy of “any willing provider”. In 2003, Alan Milburn said:
“If I can get a private-sector hospital to treat an NHS patient, then for me the person remains an NHS patient.”
Everybody in the NHS who provides NHS services will be accountable through the—[Interruption.] The money will follow. The Chair of the Public Accounts Committee is here. Where public money goes, accountability for its use will follow.
Mr Lansley
I give way to the hon. Gentleman. I will give way to my hon. Friend the Member for Stafford (Jeremy Lefroy) in a moment because I referred to Staffordshire.
Clive Efford
The right hon. Gentleman will know that the Bill introduces European competition law into the national health service, and removes the existing protection once and for all. His Government have just taken the decision to put billions of pounds into stopping Irish banks failing. If a local hospital fails under the new market arrangements, will he step in and save it?
Mr Lansley
Time does not permit me to explain the extraordinary ignorance of that series of points. First, the Bill sets out that the regulator will have a responsibility to establish a failure regime. In 2003, when the predecessors of those currently on the Labour Front Bench took the health legislation through the House, they said that they would introduce a failure regime, to be implemented by Monitor, in legislation. They never did so. At the moment, there is therefore no proper failure regime.
Secondly, European competition law—indeed, competition law—applies in this country. A body was established in the national health service under the previous Labour Government called the co-operation and competition panel, the express purpose of which was to apply competition rules in the NHS. To that extent, all the Bill will do is to ensure that the rules that already apply are applied fairly, consistently and transparently across all providers.
Clive Efford
Will my right hon. Friend confirm that in order to shoehorn private enterprise into the NHS, the regulations are being written to add a 14% premium into the tariff for private sector companies that will be tendering for work?
John Healey
My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.
Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.
If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.
Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.
Clive Efford (Eltham) (Lab)
This is a very dark day for the future of our national health service, particularly for those who have spent most of their political lives campaigning for and supporting the NHS. Some of us remember what 18 years of Conservative government did—the hospital closures and continually increasing waiting times that patients had to endure. One of the first cases that came through my door when I was newly elected to Parliament was that of someone who had been waiting 18 months for open-heart surgery. His wife came on his behalf, pleading for something to be done. I am pleased to say that he was treated under a Labour Government and that he is still alive today.
In contrast, this is a good day for those who have always hated the national health service. I remember a former Tory MP, Matthew Parris, who became a journalist, going on TV at around the time of the 1997 election and being asked, “What is it about the Conservatives and the NHS?” He replied, “It is quite clear—they hate it.” They hate the idea that they pay taxes and that the “undeserving poor” get equal treatment in the NHS, and they do not accept that people should be treated according to clinical need. That is why they continually chip away at the NHS. I do not blame the Tories, because they are just doing what Tories always do to the NHS, but when people went to the ballot boxes and voted Liberal Democrat in the last general election, they did not vote for the destruction of the NHS.
Many Government Front Benchers have campaigned against hospital closures, but the impact assessment for the Bill clearly states that Members of Parliament and local councillors should not be allowed to influence any decisions about hospitals in future. The Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), looks surprised, but that is in the impact assessment. Did she not read it? No wonder the Government did not publish it until last Thursday. It says that anyone on the Government Benches who campaigned at the last general election to keep a hospital open will be prevented from influencing decisions in the future. In order to secure a market and prevent it from being unduly influenced by political interference—in order to create a fair marketplace—politicians will be denied the opportunity to influence what is going on. That is in the Bill and the impact assessment. Before any Liberal Democrat votes tonight, I urge them to check that impact assessment, because if they do not, they will be voting for something without appreciating what is coming down the road.
I fully support the idea that GPs will be champions on behalf of their patients, but I am sure that the measures will be a bit of a curate’s egg in that respect. Howard Stoate, a former colleague of ours, supports GP commissioning and I have no doubt that if I were his patient I would be very pleased to have him as my GP, but unfortunately not every GP is a Howard Stoate. The issue with what is going on and what is being changed here is that GPs will not perform in the same way across the board. We saw that with the Tomlinson review and GP commissioning before—a lot of them became property developers. They top-sliced capital money, developed their properties, sold them off at a profit and moved down the road. We have seen all this before.
Clive Efford
No, I am not going to give way.
What about the idea that there will be patient choice and that patients will have some idea of where to go? Are we going to get all the information about private sector providers? Are they going to publish their performance data in the private sector when patients are making up their minds whether to use them or not? I suspect that we will get what we got before with these sorts of changes—commercial confidentiality; we will be told, “We can’t possibly tell you that because that would harm our performance in the marketplace.” That is what we got before and I do not doubt that we will get it again.
Let me address the comparisons that we have heard from Ministers.
Clive Efford
Members can just sit there and listen. [Hon. Members: “Give way!”] They put this ridiculous Bill up—they can sit there and listen.
The comparisons that we have had from the Government about performance on heart disease and cancer involve the selective use of statistics to try to prove their point. The Appleby review clearly states that on current trends, by 2012—[Interruption.] I am not reading my notes; I do not know whether the Minister has noticed. Appleby states that by 2012 this country’s performance in relation to a number of cancer treatments will exceed that of France, which in 2008 spent 28% more than us, as a proportion of gross domestic product, on health. We have only just reached the European average in terms of expenditure on the national health service and, as other hon. Members have said, it is time to let the NHS bed down. The time for change is not now. We should allow that expenditure to have the effect—
Public Health White Paper
Clive Efford Excerpts(15 years, 3 months ago)
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Mr Lansley
I am wedded to achieving improvements in public health. Interestingly, today I have been accused both of being an exponent of the nanny state and of having abandoned it in favour of “nudge”. The truth is that, as one sees in the White Paper, there is a clear philosophy here that we will pursue a voluntary approach, regulate only where necessary and seek to have less intrusive and less interventionist approaches in order to make more progress more quickly. If we do not make progress through voluntary approaches, we will of course still have to protect the public’s health and we will seek other measures to do so, but they have been tested to destruction by the previous Administration. It did not happen—they did not succeed and they did not improve public health—but we are determined to do so.
Clive Efford (Eltham) (Lab)
The Secretary of State consistently comes to the House and announces policies that seem to have been written on the back of a fag packet from the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), but in his explanation on this morning’s “Today” programme the Secretary of State could not even make his mind up about the fag packet. Does he understand that the time allowed for the implementation of legislation that has been passed by the House was meant to allow people who are consequential in delivering that policy enough time to plan for it? The delay that he has introduced has made it more difficult for people such as the newsagents whom he spoke about in his statement because they have to prepare. Are we going to have branding or not? Will packets be on display or not? What is the Government’s policy?
Mr Lansley
I think that I have already answered that question. The hon. Gentleman at least among Opposition Members seems to have understood what it is to be in opposition: the point is simply to oppose and that is all he is doing. This is a positive statement and he should address it in that light.
NHS Reorganisation
Clive Efford Excerpts(15 years, 3 months ago)
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Paul Burstow
It will be very much up to the consortiums to decide how to configure their governance. What we have said is that this is about the devolution of power. My hon. Friend was not against the devolution of power to the devolved Administrations in Scotland and Wales, yet this is about the same thing—shifting power away from this Front Bench and Whitehall and putting it back into the hands of patients and clinicians. Those clinicians will be engaged in commissioning, as we need them to be.
Much has been made of accountability. Under Labour, the NHS lacked it. The hon. Member for Kingston upon Hull North (Diana Johnson) really should reflect more on what was done under Labour, because there was a huge democratic deficit. We will have greater transparency and, through our new council health and well-being boards, genuine democratic accountability.
In the Labour motion before us today, it is wrongly claimed that the NHS has not been protected and that promises have been broken. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) referred to the 1950s, but I would refer her to the 1970s, when Labour was busily cutting back—
Paul Burstow
No. The hon. Gentleman arrived very late and was not in his place for much of the debate.
We heard a breathtaking attack from Labour Members who argued against ring-fencing. Indeed, just a few weeks ago, we heard the right hon. Member for Leigh (Andy Burnham) say:
“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.
That was, and is, Labour’s view—cuts to the NHS. That is not the coalition’s view. That is why the NHS will get real-terms growth. Yes, it is a tough settlement; yes, there needs to be scope for increased productivity; and yes, management costs in the system need to be reduced. The Government, however, are determined to ensure that we reform the national health service, deliver the clinical engagement and deliver the change that will make the service better for our public. I urge the House to reject the motion.
Question put.
NHS White Paper
Clive Efford Excerpts(15 years, 7 months ago)
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Mr Lansley
GP practices will all have to be members of a consortium, otherwise it will not be possible for them collectively to commission emergency and urgent care, and they will need to do that.
Clive Efford (Eltham) (Lab)
The Secretary of State seems to misunderstand one thing. When patients go in to be treated by a GP, they expect to get the best possible treatment available. The Secretary of State said in an earlier answer that he would expect patients to have the knowledge of drugs to be able to determine whether a GP was supplying cheaper or better drugs. What local accountability will there be of GPs, what resources will be put into HealthWatch networks, what resources will be left available for local health improvement budgets, and what teeth will local authorities have to impose local health plans?
Mr Speaker
Order. That was four questions, to which one answer will suffice.