Health and Social Care (Re-committed) Bill

Debate between Lord Lansley and Owen Smith

Wednesday 7th September 2011 Commons Chamber

[Owen Smith]

Yes. The current situation is clear: the Secretary of State has a legal duty placed upon him in the legislation to secure and provide—not just to promote—a comprehensive health service in this country, and to issue direction to PCTs and SHAs, such that they so do. Those two crucial aspects of the current legislation are being changed in the Bill, and I intend to discuss them in a moment.

In version 1 of the Bill, the Government were less coy, because it actually excised section 1 of the original 1977 Act. After the deluge of criticism, however, they decided that they needed to put it back in, making it explicit, as they put it, that the Secretary of State will be responsible, as now, for promoting a “comprehensive health service”.

Section 1 of the Act was duly reinstated, as was the duty to promote, but there was a critical change, in clause 1(2) of the new Bill, which diluted the traditional duty to provide and secure. Ultimately, it placed a duty on the Secretary of State only to

“exercise the functions conferred by the Act so as to secure that services are provided”.

I shall come on to the reason why that is significant, but equally significant and allied to it was the retention—against the advice of Opposition Members and many others—of clause 10, which amends section 3 of the 2006 Act, thus keeping commissioning bodies, not the Secretary of State, as the parties with a legal duty to provide health care in England.

The net effect of those changes—despite what the Minister said earlier, and despite what the Secretary of State has said on several occasions, including notably on Second Reading—is no change. The Secretary of State is still, as the Minister put it, washing his hands by divesting himself not of the NHS but of a direct duty to provide a comprehensive health service. That is the distinction which the Minister failed to make today. The Secretary of State is palming off that precious duty, which has been placed upon successive Secretaries of State, and handing it on, via the mandate, to a quango and to unelected commissioning bodies.

[The Secretary of State for Health (Mr Andrew Lansley)]

If the shadow Minister is so concerned about the Secretary of State’s legal ability directly to provide services, will he answer me a question? Does he know the last time the Secretary of State for Health actually directly provided any services? In the Department of Health, we cannot find out when it was.

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[Owen Smith]

With the greatest respect to the Secretary of State, who I have to confess knows a lot about the NHS and about the health service in this country, I think that that question is completely erroneous—a total red herring. As I said earlier, the practical reality is that the Secretary of State delegates—[Interruption.] No, no, no. The Secretary of State delegates to PCTs and SHAs his powers to provide, but, as I am going to tell the Secretary of State, he will know that under the aegis of this new Bill he will not have the power to direct clinical commissioning groups to do what he says, so he will not have a direct personal duty to provide. On the courts, we heard another interesting thing earlier from the Minister of State. He said that it was okay, because the Secretary of State will be able to justify in court when he directs a CCG to act. That is very important, and I am keen to hear the Secretary of State’s response to it, but I do not think that he has one that will convince us.

[Mr Lansley]

The hon. Gentleman has admitted that for decades the Secretary of State has not directly provided services, and I know that that is true. The issue is about having a legal duty, not to provide services but to secure the provision of services. He admits that that is done through delegation, which is in the structure of the Bill through the delegation of that responsibility to the national health service commissioning board and the CCGs. The mandate, which my hon. Friend the Minister has clearly explained, is much more transparent and accountable to Parliament for the manner in which the Secretary of State secures the discharge of those duties.

[Owen Smith]

With respect, there is not a legal duty on the Secretary of State to provide, as there has been in successive health Bills. When Bevan talked about hearing the bedpan dropped on the ward in Tredegar, he did not mean that he wanted to pick it up. [Interruption.] I do not know whether the Secretary of State wants to listen. Bevan did not mean that it needed to be picked up by the Secretary of State, but he certainly meant that he would like to be able to direct those responsible operationally for picking it up so to do.

The critical difference in this Bill is that the Secretary of State will divest himself of not only the duty to provide that service, but the power to direct the operational parts of the NHS, save for—[Interruption.] The Minister is waving his head, nodding or something; I know what he is going to say. Under the Bill, save for in cases of crisis or emergency, the Secretary of State will not have responsibility for running the day-to-day operations of the NHS.

Health and Social Care (Re-committed) Bill

Debate between Lord Lansley and Owen Smith

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

I had better give way to the hon. Member for Pontypridd (Owen Smith) first, as no Opposition Front-Bench has previously intervened.

[Owen Smith (Pontypridd) (Lab)]

Is it not disingenuous of the Secretary of State to keep repeating that the application of competition law is not expanded or changed by the Bill? We know that the change in the architecture of the NHS—the use of competition law, the writing of competition law into the architecture of the NHS, and the entry of lots of other providers into a genuine marketplace—will lead to competition law increasingly being used by people who wish to provide NHS services, breaking up the NHS. Labour Members have repeatedly stated that, and it has been confirmed by independent legal advice. That is our point. It is straightforwardly the case, and I suggest that it is disingenuous to say competition law does not apply.

[Mr Lansley]

I did not say that competition law does not apply; if the hon. Gentleman is going to attack me, he might at least get what I said right. I said that the Bill does not change the extent of the application of competition law. The House should know that the debate about the extent to which competition law, and in particular EU competition law, is applicable within the NHS is a matter of debate among lawyers. That is because it has not been tested in courts, but it was always going to be tested in courts and it is much more likely to be tested in them if we do not pass this measure, which not only gives Monitor a responsibility to be the concurrent competition jurisdiction, but, through its licensing powers, allows it to take ex-ante steps. The hon. Gentleman therefore misses the point; the point is that by introducing the private sector into the NHS before the last election, his party’s Government inevitably extended the application of EU competition law in respect of NHS providers—not NHS commissioners, I might add. To that extent, he has therefore missed the point. EU procurement rules have applied, and continue to apply. We cannot change that.

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[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.

[Owen Smith]

Let me clarify a remark that the Secretary of State just made to my hon. Friend the Member for Easington (Grahame M. Morris). The Secretary of State said that there would be no instances where NHS properties might be transferred to private companies, but he will know that under schedule 23 there is provision for precisely that. Such companies are described there as a “qualifying company”. A licence holder could be a private company to which NHS material—even staff—and other liabilities might be transferred. Is that not right?

[Mr Lansley]

The point I am making is that we are not transferring foundation trusts or NHS trusts into the private sector. We are not planning to do that. The particular case to which the hon. Member for Easington (Grahame M. Morris) referred was misrepresented as a proposal to transfer the ownership of NHS organisations. There is no such proposal; we are not planning to do that.

As I have described, the Bill would establish a comprehensive system of regulation focused on protecting and promoting patients’ interests and applicable to all providers of NHS services. The purpose of part 3 is to protect our health services from the unrestrained operation of market forces—otherwise, why would we want this structure of regulation? That is why it is there. The provisions will ensure that services are not destabilised or undermined and will protect the public and patients’ interests.

Let us consider the implications of the Labour party’s amendment 10, which would remove part 3 of the Bill. The impact of removing part 3 would be to expose the NHS to the full force of competition law, as I described earlier, without the safeguard of a health sector regulator and without any sensitivity to the needs of patients, health services and our NHS. It should not be beyond the wit of Opposition Members to recall the impact on the health service and, in particular, on pharmacy services, when the Office of Fair Trading undertook an inquiry into the provision of pharmacy services from a competition perspective without any reference to the health perspective.

NHS Future Forum

Debate between Lord Lansley and Owen Smith

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I say three things to my hon. Friend. First, let us be clear that there is £11.5 billion of additional cash available to the NHS over the course of this Parliament—but we have to use it better and deliver greater quality and effectiveness. The job of the commissioners and Monitor together is to deliver that—partly through tariff development in ensuring that they get those efficiencies by the price that they set, based on benchmark-to-best practice prices, but also through using their commissioning strength to design services. We all know that if we simply said every year to the NHS, “You must save money by cutting the price of what is paid to you”, its response would be to cut services, cut staffing or cut quality. In fact, achieving greater quality and effectiveness is about the redesign of clinical services—the transfer of services into the community and keeping people well at home rather than through emergency admissions to hospital. It is about clinical leadership and clinical redesign, and that is what these proposals will bring to the forefront.

[Owen Smith (Pontypridd) (Lab)]

Given the Secretary of State’s manifest interest in Wales, I invite him to come to Wales to meet some Welsh patients with me to find out at first hand which party they trust to safeguard the heritage of the NHS—Labour or the Tories. I suspect that the answer would be revealing for him. How much Welsh taxpayers’ money has been wasted on this needless reorganisation of the NHS?

[Mr Lansley]

The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.

NHS Reorganisation

Debate between Lord Lansley and Owen Smith

Wednesday 16th March 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman has now learned that, if one is trying to pray somebody in aid, it is best not to insult them at the same time.

We have made it clear that we need to protect the NHS now and for future generations through modernisation. Under the Labour party—

[Owen Smith]

Will the right hon. Gentleman give way?

[Mr Lansley]

Ah! Now we really do have somebody who can explain why in Wales the Labour party is cutting the NHS budget while we are increasing it. Come on!

[Owen Smith]

That is happening as a result of the very difficult decisions being taken in Wales, having seen the Welsh Assembly budget cut by £1.8 billion by the right hon. Gentleman’s Government. What we are not doing in Wales, however, is effectively privatising the NHS, exposing it to competition law or stuffing the mouths of private companies with public gold.

[Mr Lansley]

Let us remember that, when we decided to support the NHS here, through the Barnett formula by extension, money was provided to the devolved Administrations, but the hon. Gentleman confirms that a Labour-led Welsh Assembly Government chose not to invest in the NHS, while we in England chose to do so. I urge Welsh voters to remember that when they come to the elections in May.

Under the trade union thumb, Labour is turning its back on modernisation in the NHS, but the NHS cannot be preserved for the future and protected by neglect; it is not something that sits in a static format. It has to change to improve. When the number of managers in the NHS doubled under Labour, when results for patients in many conditions remain way below those achieved in other countries, and when the number of patients placed in mixed-sex accommodation runs into the thousands every month, the NHS needs to change.

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[Tom Blenkinsop]

rose—

[Owen Smith]

Will the Secretary of State give way?

[Mr Lansley]

No, I have given way to the hon. Gentleman before. [Interruption.] He only gets one shot.

Let me make it very clear. Our cuts in bureaucracy—

Swine Flu

Debate between Lord Lansley and Owen Smith

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising.

[Owen Smith (Pontypridd) (Lab)]

Will the Secretary of State tell us what role primary care trusts and strategic health authorities are playing in dealing with the crisis? Will he explain what dismantling the SHAs and PCTs will do in terms of central planning for future crises?

[Mr Lansley]

The role of SHAs and PCTs is, as in previous years, to manage the NHS response to winter pressures. In future, the commissioning consortiums together with the NHS Commissioning Board, will fulfil similar responsibilities. In future years, there will be a stronger ability to integrate the response of the Department of Health and the Health Protection Agency, working together as one new organisation, Public Health England, which will have a stronger public health infrastructure.

Contaminated Blood

Debate between Lord Lansley and Owen Smith

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I give my hon. Friend that assurance. We will take all the steps that we possibly can, not least on behalf of the bereaved families of those who died before 29 August 2003. That anomaly, among others, ought to have been rectified long ago.

[Owen Smith (Pontypridd) (Lab)]

I, too, welcome the statement—in particular the serious and commendable way in which the Under-Secretary of State has dealt with this important issue. However, the people who really need to be congratulated today are the campaigners such as the family of my constituent Leigh Sugar.

I take the Secretary of State back to his comment that the measure will apply to England only. Will he explain the rationale for that? The previous schemes applied to England and Wales, although they predated devolution. Is he saying that no additional funds will be available for Welsh patients, under the Barnett consequentials, to provide similar funding in Wales?