Health and Social Care Bill

Andrew George Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

No. I am going to make some progress.

The Labour party, when in government, pioneered patient choice; Labour said, “We must have patient choice.” I remember John Reid, when he was a Member, saying that the articulate and the well-off negotiated their way through the health service, and that he wanted to give choice to everybody in the health service. He was right. The social attitudes survey in 2009 found that more than 95% of people felt that they should have more choice, but that fewer than half of patients actually experienced it. The Labour party started down the road of extending choice; we will complete that journey.

[Andrew George (St Ives) (LD)]

On patient choice in health service design, is the Secretary of State aware that in Cornwall the primary care trust has engaged in the transfer of community hospitals and services without adequate public consultation and at breakneck speed? If “no decision about me, without me” is to apply to service design and patient involvement, is he prepared to intervene to ensure that the public are involved in such important decisions?

[Mr Lansley]

I am grateful to my hon. Friend for that point. I have not previously been asked to comment on the matter, nor have I received information about it, but from my visits to Cornwall I entirely endorse his view about the importance of community hospitals in accessing services. He will see that, in the Bill, a specific duty is placed on the commissioning board and each commissioning consortium to reduce inequalities in access to health care. He will see also that, through the Bill, we will strengthen accountability where major service change takes place, because it will require not only the agreement of the commissioning consortium, representing as it were the professional view, but the endorsement of the health and wellbeing board, which includes direct, local, democratic accountability. Points have been made about what was in manifestos, but the Liberal Democrat manifesto was very clear about the need for democratic accountability in health service commissioning—and so there will be.

Let me return to the point, because the previous Government also went down the route of practice-based commissioning. It was their policy, but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall) said, many GPs felt that

“they didn’t always get the power, responsibility and resources they might have wanted.”

Well, now they will, and we will give it to them.

On our definition of quality, Opposition Members say “quality matters”. It does, and it was under the Labour Government that Ara Darzi pioneered the thought that quality must be at the heart and an organising principle of the health service. It is we now who are going to make that happen. We are publishing quality standards. We are putting into this legislation a duty to improve quality that extends to all the organisations that commission and provide NHS services.

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[John Healey]

The problem for PCTs, and the managers and staff who work in them, is that they are being asked to do several things at the same time: to make unprecedented efficiencies at a time when the NHS is being put through its tightest financial squeeze in history; to axe its own jobs; and to guide the reorganisation and ensure that it can take place. That is a tough challenge for anyone. I am sure that the hon. Gentleman will keep on his local PCT’s case.

[Andrew George]

I am grateful to the shadow Secretary of State for giving way. I would accept his criticisms more openly—I think—were he prepared to acknowledge that the previous Labour Government set up independent treatment centres and rigged the market to hand over 15% of all elective operations in an area such as mine to an independent company that they more or less set up themselves, and which undermined the local acute trust and services with changes that patients had not asked for. That was forced on the PCT and not something for which it asked. It was a rigged market. Would he like to apologise to the House for the practices of the previous Labour Government?

[John Healey]

I am more interested in what we will be facing in future. I am more interested in the claim by the Health Secretary that there will not be, as he describes it, a rigged market in future, but a level playing field for all providers. However, my hon. Friend—[Interruption.] Well, we will see. The hon. Gentleman is a member of the Select Committee on Health, and he follows such matters closely. I urge him to read page 42 onwards of the impact assessment, because there he will see the preparations for being able to pay for the sort of thing that he criticises in the health service.

As the hon. Gentleman gives me this opportunity, let me say to him and his Lib Dem colleagues that what we are facing is clearly Conservative health policy, not coalition health policy, and certainly not Lib Dem health policy. The main evidence of any influence of Lib Dem ideas on health policy in the coalition agreement was the commitment to

“ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.

The Bill abolishes PCTs. The Lib Dem policy priority before the election was to ensure that local people had more control over their health services. The Bill places sweeping powers in the hands of a new national quango—the national commissioning board—and a new national economic regulator, which is charged with enforcing competition, to open up all parts of the NHS to private health companies. The Lib Dems’ principal concern was to strengthen local and public accountability of health services, but the Bill seriously restricts openness, scrutiny and accountability to both the public and Parliament. It will lead to an NHS in which “commercial in confidence” is stamped on many of the most important decisions that are taken. I therefore say to the hon. Gentleman and his Lib Dem colleagues: this is not your policy, but it is being done in your name. The public will hold you—

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[Mr Barron]

I am not saying that savings should not be made. Indeed, the Select Committee in the last Parliament took evidence from the chief executive of the NHS on that particular point. The case that I make is about the type of reorganisation. Not only has nobody in the public sector ever been able to get 4% a year in savings, but nobody in the private sector has, in the time scale being predicted now. [Interruption.] The Secretary of State says that that is rubbish—it is not rubbish at all. He should go and talk to his advisers about what happens in the real world, as opposed to the world that has appeared since July last year.

I would like to say something in defence of managers. This Government have been bashing managers in the NHS every week they have been in office, and did so for many months before they got there. How do they think we got waiting lists for things such as new knee and hip joints down from years to months, and even weeks, in areas such as mine? I will tell them. It was not done by taking the surgeons out of theatres to do the administration, but by putting people in to do the administration so that the surgeons could spend more time in theatres seeing more patients. That is the real truth. The management -bashing that has been taking place of people inside the NHS might be popular on the ground, but let me say this to the Government: if they take those managers out and we go back to the waiting lists and waiting times of five or six years ago, they will see where popularity lies.

[Andrew George]

Will the right hon. Gentleman give way?

[Mr Barron]

No, I will not; I have given way twice. The hon. Gentleman can make his own speech.

The King’s Fund, which the Secretary of State mentioned, supports some parts of the Bill. Indeed, I support a lot of its aims, but I do not support the reorganisation and upheaval that it will create inside the NHS. That is why I will vote against it. The King’s Fund says:

“The Bill abolishes the Health Protection Agency, places a duty on the Secretary of State to promote public health, and transfers responsibility for public health to local authorities.”

I agree with that. However, the Bill does not give me any confidence that GP consortia will have responsibility for the health of the population they cover.

Anybody looking at the history of public health in this country should recognise that we cannot run it on the basis of just handing it over to local government. The issues are far wider than that. The Secretary of State shakes his head, but people should look at the answers to questions that I got a week or so ago about what has happened to smoking cessation since this Government took over. Rates of smoking cessation have plummeted because of the advertising and promotion that is permitted. About 50% of health inequalities are created by smoking. The Government have taken their foot off the accelerator on the main thing that we should be doing to address public health inequalities, and they will suffer at the polls because of it.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the right hon. Member for Croydon North (Malcolm Wicks) and his encyclopaedic questions. I am sure that, from his many years as a Minister, he knows the kind of comprehensive answers that he would like to receive from Ministers. Indeed, I should be interested in some of those answers, so I congratulate him on asking those questions.

Perhaps I should inject a short note of levity into what has been a serious debate so far. I do not have the timing or skills of the late, great Tommy Cooper, but he once told a joke that goes roughly along these lines. A patient runs into a doctor’s surgery and says, “Doctor, doctor, I think I’ve broken my arm. Can you mend it?” The doctor looks at the arm and says, “Yes, I think I can mend it.” Then, the patient says, “Doctor, doctor, will I be able to play the piano?” And the doctor looks carefully at the arm again and says, “Yes, I’m sure that you will be able to play the piano.” To which the patient says, “That’s great. I’ve always wanted to play the piano.”

Doctors often use that joke to emphasise the unrealistic expectations that people have of them, and I have come to the conclusion that there are some unrealistic expectations in the Bill. It is well intentioned and not, as the hon. Member for Eltham (Clive Efford) and others have argued, generated out of malice, dogma or—clearly—ineptitude, but Ministers have perhaps allowed their enthusiasm to get the better of them. There can be no disagreement with the principles that underpin the Bill, in particular greater clinical and patient involvement and driving the quality of innovation, albeit through a number of, admittedly, rather debatable measures. Those are pretty unarguable “motherhood and apple pie” principles that ought to underpin such legislation, but many people are concerned about its timing, when all parties agree that the NHS faces one of its biggest ever challenges: the biggest savings it has been asked to make in its 62-year history. At the same time, however, I see the measures as the biggest shake-up of the NHS in its 62-year history. The Bill is well intentioned, but for it to proceed and not damage the NHS it needs further major surgery in Committee before it returns to the Chamber for Report and Third Reading.

We need to look at reforming the reforms themselves as part of a constructive approach to engagement. It is not that PCTs are the be-all and end-all of future health service delivery; far from it. No one will die in a ditch to defend them, but, given the institutional architecture that they have provided, after many years of coalescing around and amalgamating the primary care groups that were their heritage, we should establish the default position of assuming that we stick to that coterminosity and structure and then graft on wider clinical involvement. Many GPs in my constituency clearly tell me that they are going ahead with the measures before us more out of resignation than enthusiasm for solely GP-led clinical involvement in commissioning. A lot of them are telling me clearly that they want wider clinical engagement. If there are already 141 pathfinders covering just half the population of this country, at the very least there will be somewhere in the region of 300—that is, 300 chief executives against 152. There is a risk that that will generate a great deal more bureaucracy than exists at present in the PCTs.

I am not persuaded by the level of democratic accountability of the wellbeing boards. Monitor will set a maximum tariff and then promote competition, which could easily put quality at risk for the sake of price. That view is shared by many authoritative bodies.

Many questions still need to be addressed—protecting the integration of services, ensuring the accountability of Monitor and looking at the power of the NHS commissioning board. For those reasons, and a number of others that I do not have time to explain, I cannot support the Government this evening.

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[Andrew George]

My hon. Friend talks about the role of GPs in cutting costs. I would be interested to hear whether, from her experience, she believes that the introduction of price competition—in which a maximum tariff would be set, below which there could be competition —will be helpful, or does she believe, as many authorities and other bodies do, that it is likely to put quality at risk?

[Dr Wollaston]

I am very confident, because I have discussed that question with the Secretary of State, who has assured me that the reforms are about competition not on price, but on quality. All doctors know that if they get it right the first time, they provide not only better care, but better value care.

GPs and PCTs throughout Devon are rolling up their sleeves and getting on with the job in hand, but to deliver the undoubted benefits of integrated care, they need to be able to work closely with colleagues in hospital, as well as with people in the community, to design those logical pathways. As I just mentioned, the Secretary of State has reassured me on the question of price versus quality competition, but it would help to spell out explicitly in the Bill that that will be protected. Professionals are understandably scared, and I hope the Minister will make the position absolutely clear in his winding-up speech.

Commissioners will not feel liberated if they are liberated from the Secretary of State but shackled to Monitor. Fundamental to the outcome of the reforms will be the powers of Monitor. I should like those powers to be carefully constrained in the Bill, so that it does not take on an unintended role. Focusing on quality and not on cost would help to bring all the professionals back into thinking that this is a positive step forward, because that remains a concern.