A and E (Major Incidents)

Geraint Davies Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend makes his point powerfully, as ever. The rhetoric that we have heard from the Labour Benches today is interesting for its absence when we have debates on Wales. It seems to the public watching this that there is one rule for England and one rule for Wales, and that Labour is satisfied with lower standards in the parts of the country that it runs.

[Geraint Davies (Swansea West) (Lab/Co-op)]

The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—

[Mr Speaker]

Order. [Interruption.] Order. These are extremely important matters, but their relevance to the question of A and E was not immediately obvious to me, added to which, unfortunately, the hon. Gentleman—

[Geraint Davies]

rose—

[Mr Speaker]

No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.

Health

Geraint Davies Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

No, I am going to make some progress.

On the day of the Gracious Speech, 60 senior NHS leaders wrote to a newspaper to warn

“that the NHS is at the most challenged time of its existence.”

Just when it needs real leadership, it is being offered a period of drift from an increasingly dysfunctional Government and, sadly, the same is true on public health. The Government should have used this moment to regain the initiative and publish regulations on standardised packaging for tobacco and smoking in cars. Ministers announced on 3 April that they would publish the draft regulations on standardised packaging later that month—that was what the Minister responsible for public health, the hon. Member for Battersea (Jane Ellison), said. They have not, and since then almost 40,000 children have taken up smoking.

The public health Minister wrote to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the shadow public health Minister, saying

“we will now push ahead”

with banning smoking in cars following the vote in this House, but we are still waiting. We did not hear anything on public health from the Secretary of State today. When will they show some leadership and set out a timetable for these important measures?

It is not hard to guess the reason for this pre-election period of NHS silence. On every measure that matters to the public, contrary to what the Secretary of State said, the evidence is clear that the NHS has gone downhill under this Government and that it is getting steadily worse.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On the subject of preventive measures, my right hon. Friend might be aware that in Britain today child mortality among those below the age of five is the worst in the western world bar Malta, at one in 500? Washington university explains the cause as the welfare and austerity changes—food banks and the like. Will he comment on the impact of some of the welfare and other changes that have made the very weakest weaker, poor and unhealthier and are making them die earlier?

[Andy Burnham]

It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?

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[Dr Liam Fox (North Somerset) (Con)]

Perhaps I may allow the House a slightly more bipartisan interlude by concentrating for the moment on a different part of the Gracious Speech, which is the part relating to our country’s national security. I was delighted to see in the Gracious Speech the Government’s commitment to the NATO alliance, which is underpinned by the hosting in Wales of the NATO summit later this year.

From 4 April 1949, when it came into being, NATO has become the major instrument of stability and security in Europe. It has taken in newly emerging democracies, such as Greece and Spain. It has been extended to countries formerly in the Warsaw pact, creating a far more safe and stable continent. It has embraced countries such as Norway in the far north and Turkey, giving us security in places where we perhaps have greatest strategic vulnerability.

However, as we approach the summit in Wales, we need to accept that there are big weaknesses inside our major military alliance. To an extent, the political and military roles that we clearly understood during the cold war have dissolved away, and western countries existing in peace and freedom have become fat on the prosperity and security that they have come to take for granted. Only four members of the NATO alliance currently meet the 2% of GDP floor of spending that they undertook to meet when they joined and, as a consequence, the European continent gives a lower priority to defence and is ever more addicted to welfare. As the Prime Minister and Chancellor Merkel have regularly pointed out, we have now reached a situation in which the European Union represents 7% of the global population, 25% of global GDP and 50% of global social spending. That picture is utterly unsustainable. It is a situation in which the pressures of defence have become great.

Of course, NATO has had recent success in the way it took charge of operations in Afghanistan, what it did in response to the invasion of Kuwait and, perhaps more successfully, what happened in the Balkans. However, not long ago the Libyan conflict showed us how many weaknesses the alliance has. We did not have enough of some key assets—such as intelligence, surveillance and reconnaissance, or air-to-air refuelling—to the extent that we would not have been able to carry out the Libyan campaign without the United States being on board. Such is the current weakness of European NATO.

We are confronted with a growing threat in the shape of Putin’s Russia, and we have stood by and watched serial bad behaviour from the Putin Government. They cut off gas to Ukraine, in breach of the NATO-Russia treaty, and we did nothing. We saw a cyber-attack on Estonia, and we did nothing. Russia invaded Georgia, parts of which it still occupies, and we did far too little. I am afraid that the signal the House sent after the debate on Syria only gave Putin the understanding that further aggression would not be rewarded with real resistance by the west, and I am afraid that the events we have seen in Ukraine are, at least partly, a result of how such decisions have been interpreted. We must be careful to ensure that our behaviour does not further reinforce that position.

We have allowed wishful thinking on Russia to replace critical analysis. We have all wanted to see Russia develop as an open, democratic, pluralistic system, but that is not going to happen, at least not under the current regime. The quicker we understand that, the better for the wider security picture. It is a bullying and thuggish regime that is not likely to change. Its modus operandi is clear: it pumps money into regimes or city states—wherever it can—to try to encourage them to be more Russia-friendly. It issues huge numbers of Russian passports to citizens in those places and then claims that it has to defend them.

The whole debate about the Ukrainian crisis misses one essential point: it is not to do with strategic or even tactical interests; it is a direct challenge to international law. Putin has said that the protection of ethnic Russians—not even Russian citizens—lies not with the states in which they live, or with the laws, constitutions or forms of government of such states, but with an external state, Russia, which can intervene to protect ethnic Russians wherever they may be. If we allow that to stand, there will be no international law, because it will sweep away every norm of international behaviour that has been accepted since world war two.

[Geraint Davies]

President Obama has made it clear that he is against Britain leaving the European Union or Scotland leaving the UK. What does the right hon. Gentleman think President Putin’s position would be on those issues?

[Dr Fox]

With all due respect to anybody outside our own borders, what the United Kingdom decides to do is a matter entirely for the United Kingdom, and what Scotland decides to do is a matter for Scotland. Nevertheless, since the hon. Gentleman asked me what I think about President Putin’s view on those issues, I will tell him what I think about Scotland. Any fragmentation would be not only a fragmentation of our country’s defences but a potential weakness inside NATO, and that is unlikely to help or give comfort to anyone other than those who are a potential threat to our national security. The hon. Gentleman raises an important point, in that events that take place inside the United Kingdom may well have resonances that are not naturally considered when decisions are being taken.

I want briefly to mention another area of national security of which the House must be very cognisant: the changing nature of the threats we face. We have gone from state threats in the cold war to the domestic terror threat we faced from the IRA, and we now face a transnational terrorist threat. That threat has come at a time when we have seen a huge growth in the internet, which allows a lot of the enemies of this country to hide. Back in 1995, when President Clinton was President of the United States, there were 130 websites in the world; at the end of 2012, there were 654 million. That is a lot of places for our enemies to hide.

Our security services need to be able to operate in the same environment as our enemies, and that to me was the essence of the great betrayal of Snowden. We depend on a moral and legal relationship between our employees and the Governments of our allied states to maintain our security, and there were three elements to what Snowden did. The first was his disclosure about the extent of National Security Agency surveillance. Had he done that inside the law it would have been a legitimate debate in a democracy, but to go further and set out the means by which our security forces carry out their business, or even potentially to set out the names of particular operatives, goes well beyond what is acceptable. In my view it goes from legitimate debate into the business of treason.

We do not have massively overwhelming security apparatus in this country. We spend 0.3% of Government spending on all our agencies put together, which is what we spend on the NHS every six days. We have good, strong oversight of our security services in this country that we should be proud of, but we must be clear when it comes to national security that peace and security are not the natural state of the world. Those things have to be fought for with every generation, and we have a responsibility to fund that appropriately. We can have neither such restricted freedom that we start to become what we claim to oppose, nor go off on a libertarian rant that takes us to a place that leaves us far less secure than we ought to be. If we get that balance right, we will be doing our duty in this House.

[Mr Peter Hain (Neath) (Lab)]

I wish to speak specifically about the pensions tax Bill and the private pensions Bill in the Queen’s Speech. The Government have proposed the biggest reform to pension tax rules in nearly a century. There is no denying that it is popular to give citizens—especially those with small pension pots—the choice to take lump sums that may be more beneficial to them than eking out a living from the small annual payments on which they would otherwise rely. Paying off a mortgage or a loan on retirement by drawing down a lump sum may well be better for such pensioners, but there is real danger in destroying good annuities. That has been going on for a few decades now, and is bequeathing a nightmare that Government policies are nowhere near capable of preventing.

We have a rapidly ageing population that is dumping a huge additional burden on the young, many of whom are already leaving university with massive debts thanks to this Government’s dysfunctional policies. Now they will be saddled with subsidising through their future taxes older people who are being encouraged to live for today and not protect themselves for tomorrow.

The closure of defined benefit schemes and the shift towards defined contribution schemes has been an utter catastrophe. Accelerated further by record demographic changes, that shift is a worldwide phenomenon and a product of the neo-liberal orthodoxy worshipped by the right hon. Member for North Somerset (Dr Fox), which has gripped Governments from the era of Margaret Thatcher and Ronald Reagan, and which this Government still seem to be in the grip of. In the US, for example, the number of defined benefit schemes halved in under 30 years, while direct contribution schemes tripled. Australia, also worshipping such neo-liberalism, saw an 80% reduction in the number of workers covered by defined benefit schemes from the 1980s.

That is the background, but there are disadvantages to the new pension freedom. For example, people might decide to spend all their pension savings at the point of retirement, dooming themselves to poverty later in life. Having saved into a pension fund, received tax relief for many years and reached retirement with a pot of money, they might be tempted to blow the lot at once, meaning that they will never have the benefit of the extra income that they would otherwise have had as they got older. If that happens, the tax relief they receive would not fund a pension, and employer contributions that they may have received along the way would end up funding immediate consumption, rather than providing a long-term income. We know that some people will do that; we do not know how many but we hope the number will be relatively low. Pensions expert Ros Altmann suggests that about 7% of people currently say that they would spend it all. In truth, it impossible to predict that accurately.

[Geraint Davies]

I am sure that my right hon. Friend is a supporter, as I am, of the idea of a British investment bank. Does he think that the Chancellor should have set up tax incentives to encourage people who have liberated their pension pots to reinvest in a British investment bank and create jobs and wealth for the future, instead of it being blown on everyday consumption?

[Mr Hain]

That is a very good point.

The new flat-rate state pension, which is cited in mitigation for this new approach to pensions, still means that a lot of people will fall back on the state having spent all their pension savings. Around 20% of pensioners will still be on means-tested benefits even after the new system starts. People might also try to game the system by taking all their pension money and recycling it into a new pension fund, getting more tax-free cash and another lot of tax relief. That could mostly benefit those who are reasonably well-off with high incomes in later life, and it could be costly in extra Exchequer spending on tax relief.

This is mainly a market problem, and it should perhaps have been possible to reform that market without the draconian retreat from annuities proposed by the Government. Would it have been possible to insist that insurers are obliged to treat customers fairly, and ensure they would be liable if they did not carry out suitability checks to identify which type of annuity was best and offer a good rate? Would it have been possible to reform the way annuities work, and allow more freedom but not complete freedom? What protections will be built into the new system to ensure that unsophisticated consumers are not left at the mercy of product providers offering poor product choices, or higher risk products that people simply do not understand and through which they end up losing significant sums? The Financial Conduct Authority needs to be on top of that right from the start, but judging by past form can we be confident of that? I have very serious doubts.

If guidance is delivered by product providers, those providers are liable to entice their customers towards more poor-value products. Experience shows that they will do whatever they can to try to keep customers’ money, or give them poor value and make extra profit. The annuity market has worked poorly for years, with rising profits to insurers and reducing value for customers. How will the Government ensure that the new products developed finally offer good value, and that the charges are fair and terms reasonable?

The Government are right to legislate to permit collective defined contribution pensions, but I warn Ministers about over-hyping the benefits. In principle, such pensions ought to be better for employers than traditional final salary schemes and better for workers than traditional defined contribution schemes, but in practice they still suffer from market and actuarial risks. Ros Altmann points out that lower earners may subsidise higher earners, and younger members may subsidise older members. The new pension freedoms to take most, if not all, of the pension pot in a lump sum, however attractive and justified that may be to certain people, may also mean that people prefer pure defined contribution schemes that they can access in retirement if they wish. Collective defined contribution schemes, admirable as they may be in principle, usually mean that people cannot just take the cash, which means they may well be less attractive for members.

My challenge to the Government is this: rather than leaving the private pension system to market providers and their whims, why not build a new system that works? We need a system with longevity that savers will understand and find confidence in—a lack of confidence in this Government’s approach to pensions is something that I imagine savers and I share. While the Chancellor’s right hand further fragments and individualises pensions through these tax proposals, the pension Minister’s left hand makes legal collective direct contribution pensions. Why should any employer move to that collective system when they can see the Treasury going down precisely the opposite route? I doubt whether many will do so.

The Government are not doing anything like enough to face up to the time bomb of our ageing society and the whole person social care that the shadow Health Secretary eloquently advocated, or anything like enough to face up to the pensions needed to underpin the new life that is rapidly overtaking us, and the whole person care necessary to protect us. The whole Government philosophy of leaving private pensions to the market and saying to citizens, “Effectively, you are on you own” has failed abysmally in the past, just as I believe it will fail abysmally in the future at a terrible cost to all of us—pensioners, taxpayers and the public in general. I urge the Government to look again and come back with proposals that really begin to meet the scale of both the pension challenge and the whole person care challenge that haunts the whole of this country.

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[David T. C. Davies (Monmouth) (Con)]

Living in and representing a constituency on the border has given me a unique insight into the different systems that have now grown up in the NHS in Wales and the NHS in England. One thing has become absolutely clear—not just to me but to any independent organisation that has looked into this—and it is that the standards of care being delivered by this coalition Government are far higher in England than they are in Wales, where the NHS is run by members of the Labour party.

The reality is that, judged on virtually any single indicator that one would care to look at, standards of treatment are better in England than they are in Wales. The waiting times for cancer have not been met in Wales since 2008; the four-hour accident and emergency target has not been met in Wales since 2009; the ambulance response times targets have not been met in Wales for 21 months; and in Wales the funding for the NHS from Labour, which claims to be the party of the NHS, has been cut by 8% while NHS funding has been ring-fenced in England.

That has led to all sorts of situations. For example, an Opposition Member talked earlier about cancer in England. In England, of those people being diagnosed with cancer less than 2% have to wait longer than six weeks for their diagnosis, while in Wales 42% of people being diagnosed with cancer have to wait longer than six weeks to receive a diagnosis. The treatment times are also different; in Wales, people wait around 26 weeks, whereas in England the wait is just 16 weeks.

Behind these dreadful statistics are a range of human stories. I was grateful to the Secretary of State for Health for allowing me to meet him with a constituent of mine, Mariana Robinson. She had been trying unsuccessfully to get treated in Wales for months and there was absolutely no interest in helping her. She wanted to be treated in England; she was one of many people who would rather be treated by this coalition Government in England than by the NHS in Wales. Finally, after a great deal of correspondence and after receiving advice from the Secretary of State in London, the NHS in Wales has finally relented in this instance, and Mariana will now be treated in Bristol. I am grateful to the Secretary of State for his help.

Even this afternoon, while I was waiting to speak, I had yet two more e-mails from people who are totally dissatisfied with the treatment they are receiving in Wales at the moment and who would be prefer to be treated in England. I was contacted by an 88-year-old veteran who had served in the Korean war in the Fleet Air Arm of the Royal Navy. He is in constant pain at the moment and unable to sleep because of a problem with wisdom teeth. He has been told that he will have to wait nine months for treatment in Wales. I do not believe that such a thing would be allowed to happen in England, but he has been told that he cannot seek any treatment in England; he has no right to transfer his health care to a place where it can be provided more efficiently.

Labour Members talked about the privatisation of the NHS. The Conservative party will never privatise the NHS; we have always believed that treatment should be free at the point of service. It is members of Labour in Wales who are responsible for supporting private health care, because they are putting patients in Wales in a situation where the only chance they have of being treated is to go and seek private health care. The 88-year-old veteran of the Korean war was told that if he wanted to have something done about the constant pain he is suffering, he would have to go private.

I was also contacted today by a lady, the retired head teacher of a school in my constituency, who found a lump in her breast. She expected to be seen by someone almost immediately, as she would have been in England, but she was told that the first appointment she will have will be some time in late August.

That is the reality of what is happening in Wales under a Labour-run NHS, and the Leader of the Opposition has said that we should “take lessons”—this is to quote him—from how the NHS is being run in Wales and try to implement them in England. My message today is to warn everyone, particularly Government Members, not to let these people be in charge of the NHS, because what we will end up with in England is longer waiting lists, slower ambulance response times, people not being diagnosed properly and no cancer drugs. Apparently, 150 people in Wales have died while waiting for heart treatment. It is an absolutely disgraceful situation.

I have talked to Government Members about a suggestion that I made in relation to the Government of Wales Bill, which is to let these people put their money where their mouth is. If they think they are doing a good job with the NHS in Wales, they should allow patients in Wales and England to opt to go wherever they want to for treatment. At the moment, we have two totally separate NHS systems, so patients in Wales do not have the right to access treatment in England and, of course, patients in England could not go to Wales. A lot of patients in Wales want to be treated in England. I do not believe there are any patients in England who would want to be treated by the Labour-run NHS, but perhaps there are some out there who fancy waiting longer to be diagnosed and then waiting longer again to get the treatment that they have a right to expect.

Let us see Opposition Members supporting a change to legislation that would allow patients in England to be treated in Wales, with the money required being added to the block grant given by the Government to the Welsh Assembly every year, and patients in Wales who want to be treated in England having the right to access that treatment in England, with the money required being deducted from the block grant that is handed over to the Labour party in Wales every single year. And let us see the direction of movement, because I know that an enormous number of people will immediately opt for the lower waiting times, the better diagnosis and the wider access to drugs that are available to people in England.

[Geraint Davies]

Does the hon. Gentleman accept that there are only 3 million people in Wales, and that when we compare Wales with a lot of the English regions and hospitals we do just as well? In London, we obviously have international centres of excellence. In Wales, we spend more cash per head. There is a sparser population and more nurses per 1,000 people, and we have better results on cancer than elsewhere, so there is a mixed picture. He is being completely political and undermining the morale of people working in the health service in his constituency; it is disgraceful.

[David T. C. Davies]

It is not a mixed picture at all and we should be very clear about that. People wait longer for treatment in Wales than they do in England. People wait longer to be diagnosed in Wales than they do in England. People wait longer for an ambulance in Wales than they do in England. Money for the NHS is being cut in Wales and it is being ring-fenced in England, because the NHS will be a priority.

The real disgrace is that Labour Members have always prided themselves on being the party of the NHS and have gone out of their way to do so. Because they have that reputation, they know that in Wales, and possibly in England too if they ever end up running things, they can get away with making cuts and with cosying up to the unions because they feel that people will trust them.

I say to anyone independent and impartial who wants to know what it would be like for NHS patients if Labour Members ever get into government, they should look at what is happening in Wales right now.

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[Geraint Davies (Swansea West) (Lab/Co-op)]

The first line of the Queen’s Speech said that the long-term plan was to deliver a strong economy and a fair society. Failure to deliver in that regard is contributing to aggregate health costs in Britain. The question is how we use the existing budget to deliver better health, as opposed to increasing the aggregate amount of money that we spend on health to the levels that are enjoyed in the European Union and the United States. The answer must be to reduce some of the drivers of health costs and the conditions that are causing those costs in the health service.

Obviously, the first driver is smoking. The Government have an opportunity to change packaging, stop children smoking in cars and accelerate the rate of transfer to e-cigarettes. There could be great savings there. At the moment, it costs us £5 billion a year to treat people for smoking-related diseases.

The second driver is obesity. The Forsyth report suggests that, by 2050, half the UK population will be obese. There are issues about school meals and exercise. There is an option—I do not know whether the Minister is interested in this because he is looking at his iPad—to put a 20% tax on sugary drinks, which is seen in New York, Mexico, France and Norway. Oxford university thinks that such a measure would reduce the numbers of obese people by 180,000 and of overweight people by 285,000, and generate about £250 million of revenue, which could be hypothecated to fund cheaper fruit and vegetables for poorer communities.

The reality is that only 10% of young people under the age of 18 consume their five fruit and vegetables a day, but children under the age of 10 are consuming 19 grams of sugar. There is a case for a sugar tax. Coca-Cola contains 11 spoonfuls of sugar, and there is 50% more sugar in sugary drinks than is advertised. We need to discriminate between certain ingredients, such as fructose versus glucose, because of their medical impact. It has been noted in America that fructose creates a different sort of fat cell in the liver and the heart, which causes much higher mortality rates. We need to focus in on the fact that there are different sorts of fat. Ironically, the EU, which I normally support, has suddenly agreed with the fructose lobbyists that fructose should be called healthier because the high from it is not as quick, but the damage is much greater. The same goes for palm oil, which is a big killer in America.

Some of these issues are about taxing ingredients in processed foods. Madam Deputy Speaker, if I gave you a potato and told you to make some money out of it, you probably would not—or you might because you are a good person—just sell that potato. The way to make money out of the potato is to smash it up, add fat, salt and sugar, reform it as Dennis’s dinosaurs, put some packaging around it and a jingle on it and get children who are poor into the habit of consuming a large amount of it, so they die an early death. We should be aware of that, and we should be the guardians of the budget and of the people.

The same is true of advertising. If one looks at the back of a cereal packet, it will say low fat, but what it means is 50% sugar, and sugar is fat. Sugar is converted to fat if it is not energised through exercise and the like. We should be here to protect people from that, but we have dismally failed to do so. In fact, the opposite has happened. The Government’s economic policies increase stress and poverty, which are drivers of poor health and cost.

Britain now has the worst child mortality rates of the western world, bar Malta, with one in 200 children dying under the age of five. According to Washington university, that is linked to welfare cuts, which have driven people into using food banks. We just have to look at the situation on employment. We are told that there are all these jobs—I can see the Minister trying to ignore me—but 1 million of them are on zero-hours contracts. People are moving from benefits into zero-hours contracts, which leads to discontinuity in their benefits. They are having to go to food banks. They are under stress and feeling hungry, which leads to ill health for them and their children. Research suggests that 45% of people in debt have mental health problems—[Interruption.] I can hear my hon. Friend the Member for Cardiff West (Kevin Brennan) listening to this. Research in the EU has shown that recession leads to suicide. Two thirds of people on whom the bedroom tax has been cruelly inflicted are disabled.

The Government are responsible for many of the costs, which will become intergenerational, long lasting and profound. That is part of a process of saying that the health service is too expensive for the poor, so we should privatise it. Aneurin Bevan famously said:

“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”

I should like to see a future in which that community is one nation—not the weakest crushed by the strongest—so that that cost is shared more evenly and is lower and Britain is healthier for it. We look forward to a more equal Britain in opportunity and outcome, where the health of the nation is better and the salvation of the health service is once more in our hands, with a Labour Britain next year.

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[Norman Lamb]

I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.

This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.

This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

[Geraint Davies]

Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people. He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?

[Norman Lamb]

The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.

In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.

Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.

The Government remain committed to legislating on professional regulation when parliamentary time allows.

Children and Families Bill

Geraint Davies Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

This question came up in the other place, and we have always made it clear that we are seeking the power to make regulations in the event that the Government should decide to proceed with standardised packaging, having received the Chantler review and considered everything in the round. Making the decision on those powers now would enable us to proceed apace at that point. I hope that that clarifies the matter for my hon. Friend.

As I was saying, the Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. The House would have the chance to comment further on the matter, through the affirmative resolution procedure, were the Government to decide to go ahead. It is prudent to take a comprehensive approach now, however, so that we can be prepared for the future.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Having had a background in multinational brand management, I know why multinationals invest hundreds of thousands of pounds in brand graphics and mnemonics to exaggerate sales. Does the Minister not agree that that proves that blank or standardised packaging would have an impact on sales?

[Jane Ellison]

That is for the review to comment on. I hope that hon. Members will understand that I am not trying to be unhelpful in not responding in detail to their interventions. We have put in place a process that we think will be the most robust way of making policy in this area, and I hope that the hon. Gentleman will forgive me for not commenting in detail on his point. I am sure that the review is looking in detail at all these aspects; they were certainly explored during the consultation.

Oral Answers to Questions

Geraint Davies Excerpts

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

I remind the hon. Gentleman that the last Government never published risk registers. The policy that we have adopted is therefore entirely consistent with theirs. However, as the hon. Gentleman will recognise, it is not for Whitehall to micro-manage local commissioners and health care services. Decisions of that kind need to be made locally, by local commissioners working with patient groups in the best interests of patients and local communities.

[Geraint Davies (Swansea West) (Lab/Co-op)]

10. What plans he has for regulation of the counselling and therapy professions.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We support the system of accredited voluntary registration established by the Professional Standards Authority for Health and Social Care. It has already accredited counselling and psychotherapy registers and others are seeking accreditation.

[Geraint Davies]

But the Minister knows that under this Government the number of people referred to psychotherapists and counsellors has tripled to 1 million at a cost of £400 million, and some of them are faced with so-called gay to straight conversion therapy. When will he support my Bill to regulate psychotherapists and ban so-called “gay cures”, which cause enormous trauma among their victims and are being promoted this Thursday at a big conference in Westminster?

[Dr Poulter]

As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.

If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.

Gay-to-straight Conversion Therapy

Geraint Davies Excerpts

Wednesday 20th November 2013 Westminster Hall

[Sandra Osborne]

I, too, have reason to be grateful to those people.

I want to place on the record the fact that several hon. Members indicated that they wanted to attend this debate but had other commitments.

[Geraint Davies (Swansea West) (Lab/Co-op)]

As my hon. Friend was so kind as to mention my Bill, does she agree that our joint ambition to get rid of gay-to-straight conversion therapy needs to be embraced in a regulatory context so that all psychotherapists are regulated, which they are not at present?

[Sandra Osborne]

I agree, and I will go into that further. Conversion or reparative therapy is the attempt by individuals, often posing as professionals, to alter the sexuality of lesbian, gay or bisexual patients. Virtually every major national and international professional organisation has condemned the practice as ineffective and potentially extremely harmful to patients.

--- Later in debate ---

[Geraint Davies]

Is the Minister aware that the number of people who go to psychotherapists has tripled under this Government to 1 million? Given that number and given that we have heard evidence about people being referred by GPs, is it not now high time for regulation to stop abuse and potential abuse?

[Norman Lamb]

I will come to that. I do not think that the fact that numbers have increased can be blamed on this Government.

We are not aware that the NHS commissions this type of therapy. In my replies to correspondence, I have confirmed that the Department of Health does not recommend the use of conversion therapy—I have made clear today my personal view on that—and it is not a National Institute for Health and Care Excellence-recommended treatment. That is self-evident. Furthermore, the main national professional associations for psycho- therapy have declared that they regard conversion therapy as wrong.

In February 2010, the UK Council for Psychotherapy said:

“UKCP does not consider homosexuality or bisexuality, or transsexual and transgendered states, to be pathologies, mental disorders or indicative of developmental arrest. These are not symptoms to be treated by psychotherapists, in the sense of attempting to change or remove them.

It follows”—

this is very important—

“that no responsible psychotherapist will attempt to ‘convert’ a client from homosexuality to heterosexuality”.

Similarly, in September 2012, the British Association for Counselling and Psychotherapy set out the following:

“The…Association…is dedicated to social diversity, equality and inclusivity of treatment without discrimination of any kind. BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’ therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality.”

In January 2013, the British Psychological Society published a position statement that opposed any psychological, psychotherapeutic or counselling treatments or interventions that view same-sex sexual orientations as diagnosable illnesses. It declared:

“This includes freedom from harassment or discrimination in any sphere, and a right to protection from therapies that are potentially damaging”—

that point was made by hon. Members—

“particularly those that purport to change or ‘convert’ sexual orientation.”

This issue is clearly causing a great deal of concern in the House, and rightly so. The hon. Member for Ayr, Carrick and Cumnock, as well as sponsoring this important debate, tabled an early-day motion in June. It called on the Government to take steps to ban gay conversion therapy and to investigate NHS links to conversion therapists. Several hon. Members present have referred to that motion and put their names to it.

The hon. Member for Swansea West (Geraint Davies) tabled a second early-day motion, calling on the Government to regulate counsellors and psychotherapists. There have also been a number of parliamentary questions on the issue. As hon. Members will know, the hon. Member for Swansea West has also introduced a private Member’s Bill seeking regulation of therapists. That is scheduled for Second Reading this Friday.

The Government have already said that there are no plans at this stage to introduce statutory regulation of psychotherapists. We do not believe that regulation would necessarily prevent this type of counselling in any case, as it would not depend on the type of therapy offered.

The Command Paper entitled “Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers”, which we published in February 2011, sets out the Government’s vision for the future of work force regulation. That paper makes clear our continuing view that, although statutory regulation is sometimes necessary, it is not always the most proportionate or effective means of assuring the safe and effective care of patients or social care service users. That is why we provided powers to the Professional Standards Authority for Health and Social Care in the Health and Social Care Act 2012.

The Professional Standards Authority oversees the work of the health care profession regulators, including the Health and Care Professions Council. Those powers facilitated the establishment of voluntary registers for unregulated health care professionals and health care workers in the UK, social care workers in England and certain students.

The accredited voluntary registration scheme to which I am referring is not a form of regulation, nor is the PSA a regulator. To be accredited, organisations must provide evidence to the PSA that they are well run and they require registrants to meet high standards of personal behaviour, technical competence and, where relevant, business practice, but the scheme does not endorse any particular therapy as effective and it makes it clear that accreditation does not imply that it has done so. However, organisations seeking to be accredited can set their own rules about what therapies their members can or cannot offer.

As accredited voluntary registration appears to be gaining momentum and is proportionate to the risk, we believe that statutory regulation would not be appropriate and the costs to registrants or the taxpayer could not be justified. This is not to say that we are ruling out statutory regulation for this group for ever. We will continue to assess the need for it. I give an absolute assurance about that.

This is not to say that lesbians, gay men and bisexual people cannot seek counselling or therapy because they are distressed about a particular aspect of their sexuality—that is very important—or that a therapist should not try to help their patient with whatever is causing them distress, which may involve helping them to come to terms with their sexuality, family arguments over their sexuality, or hostility from other people. Supporting people through aspects of their lives that are difficult or challenging is a large part of what therapists do. I think that my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) made that point in his intervention.

We want to minimise the risk that lesbians, gay men and bisexual people who seek counselling about their sexuality will face therapists attempting to change their sexual orientation because the therapist considers that being gay is wrong. That, of course, is completely unacceptable. That is why Department of Health officials last week met representatives from the UK Council for Psychotherapy to discuss a way forward on this important and sensitive issue. Officials will work in partnership with the council in the following ways.

First, the UK Council for Psychotherapy has agreed to draft, in consultation with the other relevant professional bodies, a public statement on conversion therapy that provides information and outlines the views held by those organisations. That is incredibly important. Once produced, that statement will be widely publicised and placed on relevant websites to ensure that individuals seeking a counsellor or therapist will be aware of those bodies’ views on gay conversion therapy.

Secondly, the Department of Health will host a round-table event in the spring to which it will invite relevant individuals and organisations in order to discuss ways to achieve greater quality and consistency across the profession in general, as well as on this specific issue. Thirdly, and subject to the progress of the private Member’s Bill, the Department will consider writing to statutory regulators, setting out key principles, to be agreed with the professional bodies.

In addition, although we are not aware of such therapies being commissioned by the NHS, my officials will explore with NHS England what actions it can take to ensure that clinical commissioning groups are not commissioning them locally. That is one of the issues that I am happy to discuss with hon. Members. I totally agree that it is not something that public money should have anything to do with.

I hope that I have assured those who have spoken passionately and persuasively in today’s debate that the Government are listening and taking action. I repeat my offer to meet hon. Members. We have a lot to be proud of. The UK is once again recognised as No. 1 in Europe on lesbian, gay, bisexual and transgender equality by the International Lesbian and Gay Association, and we continue to make great strides forward on equality. I hope that that reassures hon. Members both that this Government are strongly committed to advancing lesbian, gay and bisexual equality and that we are taking the issue of gay conversion therapy extremely seriously.

Oral Answers to Questions

Geraint Davies Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

Screening is one of the most important aspects of the work of Public Health England and we are keen to make sure that it is addressed both nationally and locally. Great work can be done by local authorities in making sure that women have this vital screening.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?

[Mr Jeremy Hunt]

That is definitely worth looking at and is exactly the kind of proposal that we could think about for NHS England. It could make a very big difference.

Social Care Funding

Geraint Davies Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

My hon. Friend, as so often on health matters, is absolutely right. This is about a partnership between the state and the citizen, recognising that the state is not able to bear all these costs on its own, and trying to create the incentives and the certainty whereby private citizens are able to make provision for their own social care costs in the way that they make provision for their pension and, as such, is a very important step forward.

[Geraint Davies (Swansea West) (Lab/Co-op)]

These proposals mean that someone with a £200,000 house pays £75,000, and someone with a £400,000 house pays £75,000. Would it not be fairer if the first £200,000 was charged at, say, 20%, and the second £200,000 at 40%, so that someone with a £200,000 house would pay £40,000 and someone with a £400,000 house would pay £120,000, so that instead of a flat-rate charge, we would have a progressive charge within the financial envelope? Will the Secretary of State consider a fairer system, rather than a flat-rate poll tax?

[Mr Hunt]

People whose houses have lower value benefit from the fact that we are increasing the threshold at which support is available. Because of that increase in the threshold, they will get some support towards paying for their £75,000, which people with higher value houses will not get.

Suicide Prevention

Geraint Davies Excerpts

Wednesday 6th February 2013 Commons Chamber

[Mrs Moon]

The figures show that the increased number of deaths are among an older group of men, largely those who have not experienced unemployment before, who find unemployment very difficult to deal with and who despair about being able to maintain their family lifestyle, pay their bills and see a future where they can again be economically successful. We must be careful that those who are unemployed and who need to survive on benefits for however short a period are not made to feel failures, a burden on the state or pariahs in our society.

I know that Ministers will probably argue that the Government are doing wonderful things in relation to benefits but the Office for National Statistic figures highlight a very worrying trend. I hope there will be discussions between the Department for Work and Pensions and the Department of Health to highlight the importance of Jobcentre Plus staff in particular being aware of claimants coming in who may well be suffering from depression and exhibiting signs of hopelessness and despair, and being able to take suitable preventive action.

Although the numbers are small compared with cancer, heart disease and dementia, suicide is a reflection of the overall health of a country and a community, and the ripple effects on the health of those impacted by it are very great. Other Members have spoken about the impact on families, but communities, schools and workplaces are also affected. There is an impact on people who have known the individual and people who identify themselves with that individual, which is where the risk is most dangerous.

[Geraint Davies (Swansea West) (Lab/Co-op)]

May I return to my hon. Friend’s point about the age profile of recent suicide victims? In going through the research, has she found that, in particular, men of a certain age, perhaps in their late 40s or early 50s, who have young children and who suddenly and unexpectedly lose their job, lose their self-esteem and cannot reposition themselves in what has traditionally been the caring-for-children role in the family setting? Does she think that there is a role for providing support to such people in regaining their self-esteem and repositioning themselves in order to get across to them that they have value in their new position, even if they do not get back their previous one, and to get them back on to a positive track rather than a downward spiral towards possible suicide?

[Mrs Moon]

My hon. Friend asks a complicated question. The research that I have looked at has considered the impact of suicide figures in recessions, not only in the UK but across the world, and it goes back in time to look at the great depression and recession that we had in the 1930s. As far as I am aware, no work has been done, certainly by that research group, on the impact on men’s self-esteem in assuming a caring role and responsibility within the family. Should I come across it, I will certainly pass it his way.

Last year, the all-party group on suicide and self-harm prevention, which I chair, considered a number of issues that we have to address in relation to suicide. Every meeting brings the best authorities that we can find into the corridors of Westminster to explain and talk about the work that they are doing.

Regional Pay (NHS)

Geraint Davies Excerpts

Wednesday 7th November 2012 Commons Chamber

[Jack Dromey (Birmingham, Erdington) (Lab)]

rose—

[Geraint Davies (Swansea West) (Lab/Co-op)]

rose—

[Mr Hunt]

I want to make a little more progress, and then I will perhaps take one or two more interventions.

NHS employers have the ability to set their own terms and conditions, but the vast majority prefer to use national terms and conditions, and provided that those remain sustainable and fit for purpose, they are likely to continue to do so. I welcome the national negotiations between NHS employers and NHS trade unions, and I urge both sides to bring the negotiations to a swift and successful conclusion. Unfortunately, the time it is taking for agreement to be reached is encouraging some employers, such as those in the south-west consortium of NHS and foundation trusts, to examine alternative provision. Sadly, it appears that the people who bankroll the Opposition—particularly Unite—would rather put their members’ jobs at risk than work with employers to find an acceptable solution to help the NHS meet its financial challenge—[Interruption.] I am sorry they do not want to hear this—

Health and Social Care Bill

Geraint Davies Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

I would say two things to Professor John Appleby. First, the latest data published in EUROCARE-4, which I know the right hon. Gentleman will have seen, are clear about the gap between cancer survival rates in this country and others, and in recent years that gap has not diminished as it should have. He can read in last week’s Lancet an authoritative study of cancer survival rates in this country and a number of others demonstrating that the gap remains very wide and that we have to close it. Secondly, the King’s Fund supports the aims of the Bill and Professor Appleby, as a representative of the King’s Fund, clearly understands, as we do, that if we are to deliver the change that is needed, we need the principles in the Bill.

People trust the NHS, and its values are protected and will remain so—paid for from general taxation, available to all, free at the point of delivery and based on need rather than the ability to pay. However, a system in which everyone is treated the same is not one that treats everyone as they should be treated. Our doctors and nurses often deliver great care, but the system does not engage and empower them as it should.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On the John Appleby point, does the Secretary of State accept that what he actually said was that the rate of deaths from heart disease would be better in Britain than in France by 2012, on current trends, even though France spends 28% more on its health service? Is not that a ringing endorsement of what is happening now rather than a prescription for blowing up the system as the Secretary of State suggests?

[Mr Lansley]

First, I have just answered the point about John Appleby. It is true in a number of respects, as I have made clear, that although there have often been improvements in the NHS, they have not been what they ought to have been. It was a Labour Prime Minister, back in 2001, who said that we must raise resources for the NHS to the European average, but he did not achieve results that compared with the European average.

Let me give the hon. Gentleman some examples. A recent National Audit Office report showed that as many as 600 lives a year could be saved in England if trauma care were managed more effectively. Too often, the latest interventions, which are routine in other countries, take too long to happen here. John Appleby used heart disease to illustrate his point. Primary PCI— percutaneous coronary intervention—using a balloon and stent as a primary intervention to respond to heart attack was proven to be a better first response years ago. I knew that because cardiologists across the country told me so several years ago. I remember a cardiologist at Charing Cross telling me, “I have a Czech registrar working for me who says that in the Czech Republic PCI as a response to a heart attack is routine, but it hardly ever happens in this country.” Since then, it has been better implemented in this country, but that started to happen only when the Department of Health gave permission for its adoption.

The same was true of thrombolysis for stroke. That happened too late in this country, after such changes had taken place in other countries, because health care professionals there were empowered to apply innovation to the best interests of patients earlier.

--- Later in debate ---

[John Healey]

If the hon. Gentleman was worried about the past, he should be a good deal more worried about the future, and, a bit like the Health Secretary, he should spend a lot less time talking about the Labour Government and what we did to the health service and more time talking about the plans and big changes to come.

[Geraint Davies]

Does my right hon. Friend accept that the core difficulty with the Bill is that it is not about patient choice but about a movement towards general practitioner choice and GP consortia choice? They want to maximise not medical outcomes but profitability. That is what this is about, and the reason is the same as what was said about flexible pricing.

[John Healey]

My hon. Friend is right. For the first time in the NHS we are facing, first, the potential for profit at the point of commissioning and, secondly, commissioning—in other words, decisions about rationing as well as referral—being made at the individual patient level, not at the collective area level, and we are looking at them being made by bodies and individuals who are not publicly accountable, including to the House.

--- Later in debate ---

[Henry Smith]

I dispute that reading of the Bill. Maternity was taken away from my local community in 2001 and is now 10 miles up the road, in another county, and accessible only by single-carriageway roads, which is at best inconvenient, and at worst dangerous for patients.

The sorry tale goes on. In 2005, under Labour, Crawley hospital lost its A and E unit to East Surrey hospital—10 miles up the road, in another county—which has been seriously detrimental to my constituents, and something that they and I very much regret.

I was struck by many of the comments of my hon. Friend the Member for Wyre Forest (Mark Garnier), because he mentioned things very similar to our experiences in Crawley—and listening to other right hon. and hon. Members, there seem to have been similar experiences across the country as well. I can speak only from my local experience, but there was an eerie resonance in the sort of downgrading of services under the Labour Government.

[Geraint Davies]

Does the hon. Gentleman accept that what his community, like other communities, will face is a local monopoly—the GP consortia—that will focus on the most profitable lines of treatment, rather than on the best treatment? Surely this is not the right direction.

[Henry Smith]

I do not see how multiple providers is a definition of a monopoly. However, I must make progress in the short time left to me.

My constituents are pleased that for the first time in many years health decisions will be made in Crawley, rather than, as has happened up until now, on the south coast, in east Surrey or up in Whitehall, and that more decisions will be made by local people.

--- Later in debate ---

[Geraint Davies (Swansea West) (Lab/Co-op)]

I am glad to be called to speak at this hour, Mr Deputy Speaker. It is my joy to celebrate the achievements of the health service that was started by Nye Bevan from Wales and to celebrate the successes of the previous Government, such as the 2 million extra people a year who are now operated on, the 44,000 extra doctors and the 94,000 extra nurses. The question to ask is: why devastate and break a system that already works well?

The Bill risks stripping out the heart and mind of the NHS, in terms of equality and planning, and replacing it with a market of GP business consortia that will focus increasingly on profit maximisation through negotiation of the best prices, bulk purchasing and threatening to withdraw custom from hospitals that cannot survive without them. Huge health retailers will evolve with local monopolies over patient communities. It is all very well saying that patients will have choice, but there will be big consortia saying, “This is what is best for you—buy this”, focusing on the areas of highest profitability. Those consortia might prefer to deal in cataracts rather than, for argument’s sake, chronic conditions. They might choose to focus in certain demographic areas with different health trends. A business focus will be applied according to the returns that can be gained in different areas rather than simply focusing on what is right for each person.

[Neil Carmichael (Stroud) (Con)]

Is it not possible that doctors’ consortia will simply make the right decisions for patients, focusing on giving proper value for money and decent care and on responding properly to local requirements and needs? Would not that apply across the piste in terms of community hospitals and acute hospitals?

[Geraint Davies]

The taxpayer invests in GPs to provide medical and clinical excellence so that they can diagnose people’s health problems. The taxpayer does not invest in them to become small business people who go around trying to maximise profit and work out rates of return on different sorts of health care. That is the problem with introducing privatisation and marketisation: the thought in the back of the business person’s head is how to make money, not simply what is the best diagnosis. The customers whom GPs are facing—patients—are to a large extent ignorant. It is not like buying electricity from npower: patients do not know what is wrong with them. They are in the hands of their GP and they do not know whether what they have been prescribed—perhaps a cheaper drug that makes a higher profit but is not as effective—is right: they just have to guess.

[Mr Graham Stuart]

Rationing is inevitable in any system, but who should best do it? Should remote managers do it away from patients’ needs, or should GPs do it in a way that involves managing and being aware of a budget but trying their best, within that budget, to deliver the best health outcomes for all their patients? Who is better—PCT managers or GPs?

[Geraint Davies]

A GP must always ask what the best treatment for the patient is rather than what the best treatment for their business’s profitability is. That is why this is fundamentally wrong.

[Neil Carmichael]

rose—

[Geraint Davies]

I shall not give way.

The Bill is setting up an incentive system that will make GPs make the wrong choices. It will return the NHS to a sort of pre-Nye Bevan, atomised system of health, rather than a planned system that uses resources efficiently. The system will lend itself, in the new era, to duplication, profiteering, businesses going bust and waste. What is more, there is no political mandate for the Bill; it is a Trojan horse of privatisation that no one knew would come. The changes will probably cost £3 billion or £4 billion to administer and will clearly set us back a number of paces before we move forward—if we do move forward.

A few people have mentioned the excellent work of John Appleby, the chief economist of the King’s Fund, who wrote in the British Medical Journal that the rate of deaths from heart disease is falling much faster here than in any other European country. It is falling to such an extent that it will be lower than the rate in France by 2012 even though we are spending 28% less. In terms of relative efficiency, we are doing well. Breast cancer rates have fallen by 40%, compared to 10% in France. I am not complacent and I do not pretend that there should not be greater productivity. If I had to point to one area in which there should be greater productivity, it would be the fact that we pay GPs too much money. That is the fault of the previous Government for negotiating a situation in which GPs can make more and more money. Now, it seems, we are encouraging them along that track, as though making a load of money were the primary focus.

My basic point is that if it ain’t broke, don’t fix it. Reform, yes: breaking the system, no. The Bill is not evidence-based. We are hurtling ahead, although people do not know the likely downside—the duplication, the amount of profit, the failures and possible hospital closures. The Bill is not economically sound or robust.

I have mentioned other difficulties one of which is that we make GPs subcontractors who want to maximise profit. In Wales, there is a move towards directly employing consultants and GPs, as opposed to giving them free rein on profit maximisation. Assuming that the Labour party wins in the Assembly election in May, we will see over the next five years the emergence of parallel systems, one of which will be a modernised version of the traditional health service and the other a marketised system. There is a conflict of interest between the profit motive and patient care, particularly in chronic conditions.

If aggregate supply is to be provided by a group of GPs, as opposed to a PCT, there is the risk of local shortages—of flu vaccines, for example. There might be local shortages in one area and excess supply and waste in other areas because of the absence of a strategic plan to deliver the right aggregate and match supply and demand.

In terms of customer and consumer watch, something called HealthWatch is to be introduced. Given the Government’s record in getting rid of Consumer Focus and bundling it in with Citizens Advice, I have little faith in the effectiveness of HealthWatch in looking after patients who, as I mentioned, are relatively ignorant of the product they are offered and face a local monopolist.

With reference to lifting the cap on private patients, as my right hon. Friend the Member for Croydon North (Malcolm Wicks) said, there is a risk that BUPA, for example, might suddenly funnel a lot of its patients in one direction because of discounted purchases, crowding out patients in a certain area. That would lead to unpredictability in the system.

We are asked to believe that the abolition of 150 PCTs and 10 strategic health authorities will miraculously save us some 45% of current expenditure. The people of Wales will make the right decision in May.