Care Bill [Lords]

Bob Stewart Excerpts

Tuesday 11th March 2014 Commons Chamber

[Jim Dowd]

I accept absolutely the hon. Gentleman’s point. The wording of the clause is such that the powers are virtually unfettered—they are untrammelled. It does not say that an administrator can make recommendations about neighbouring trusts or nearby trusts; it says that they can make a recommendation about any trust anywhere in the entire health economy. It will be a threat to every single Members’ community willy-nilly, because it will be the new norm.

I will come on to what Lewisham experienced previously, but there used to be clinically led reconfiguration panels. This Government seem to have eschewed them. They are difficult and complicated, but they need to be so because this is a premier public service that matters so much to people in every part of this country. They are eschewing that in favour of an administrative route that will give them untrammelled powers.

[Bob Stewart (Beckenham) (Con)]

rose—

[Jim Dowd]

I give way to the gallant hon. Gentleman.

[Bob Stewart]

I thank the equally gallant hon. Gentleman and a neighbouring Member of Parliament. I, too, have never understood why Lewisham hospital had to be involved in this exercise, and I still fail to see why it has to suffer as a consequence of the failure of other hospitals that, although they are outside my constituency, affect my constituents deeply.

[Jim Dowd]

The hon. Gentleman is right. We have discussed the impact of this on our constituents many times.

I will try to shed some light on why Lewisham was put in the firing line, and why such administrative vehicles are so dangerous and antithetical to good health care. On 24 July 2012, the then Secretary of State invited the Members for Bexley, Bromley and Greenwich to a meeting in his office. That is entirely logical, because South London Healthcare Trust covers Bexley, Bromley and Greenwich. Strangely, he also invited the Members for Lewisham. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) was unfortunately unable to attend, but my hon. Friend the Member for Lewisham East (Heidi Alexander) and I did attend.

--- Later in debate ---

When the trust special administration process was first introduced in 2009, Labour Ministers told the House that it was to be used only as a last resort, and that must remain the position of the coalition Government today. I believe that that is the case.

[Bob Stewart]

What worries me is the trigger for the process. What level of debt would have to be achieved in order for one of these extraordinary witchfinders-general suddenly to appear in our area to sort out our hospitals?

[Paul Burstow]

The hon. Gentleman anticipates my next point. It is far from clear how the judgment should be made that a trust is failing. In my view, the gateway to the process should be a narrow one, and it should be jealously guarded. My concern is that so many trusts are sitting on top of private finance initiative debt, and that hospitals could be at risk as a consequence. That debt amounts, over time, to about £70 billion; a significant burden has been hung around the neck of the NHS. I want to ensure that we have processes that can recognise and manage that without tipping organisations into crisis unnecessarily.

--- Later in debate ---

[Nick de Bois]

And the answer is not just with consultations. The issue facing us today, and why I cannot support clause 119, is simply this: the argument on reconfigurations, with the greatest respect to all hon. Members, will not be won by politicians or even by senior managers in the NHS. There has to be a clinically led argument from GPs upwards throughout the acute sector. For many, many years they have not made the case. The process has been littered with broken promises over the years, regardless of the good intentions of politicians. I can do nothing tonight that would suggest a further breach of trust by weakening the power of consultation, even though I accept that consultation has not had its finest hour—or, in my case, its finest 10 years.

I have faith that the voice of the British public, and the intent behind the Health and Social Care Act 2012 in particular, on which I was engaged over many weeks, is to bring clinical decision making to the front line and to empower local people, local authorities and patients further. That has been a great step. The second reason why I find it difficult to run with clause 119, and why I support the amendment tabled by the right hon. Member for Sutton and Cheam (Paul Burstow), is that he recognises the need to extend the consultation to all key stakeholders, not least to those in trusts that could be affected through no fault of their own, to extend their powers as well. That went to the heart of the 2012 Act. Indeed, we are blessed with two former Ministers in the Chamber, with whom I spent many happy hours on those Benches—it was not acrimonious at all. This was a core principle behind what we were trying to do.

Let us deal with the exceptional cases. I accept entirely that there is no master plan to run through configurations on the basis of the proposed changes, but I cannot ignore the fact that the proposed legislation we are being asked to approve allows for changes to be made in circumstances that would leave a democratic deficit and subjugate clinical judgment because of a stressful financial situation.

[Bob Stewart]

Where is the limit? That is what worries me. It is like pouring water on a tile—one cannot stop it. It might go much further than the adjacent trust area; it could go anywhere.

[Nick de Bois]

Yes, indeed. Again, I am trying to be as balanced as I can. I recognise that no single institution can stand in isolation, and I think that that is broadly accepted. However, to make decisions within 40 days on institutions, when we do not know which institutions will be affected or how they will be affected, is demanding too much of a service that is so valued by the public.

--- Later in debate ---

[Dr Poulter]

I will give way to the former Secretary of State in one moment, but I would like to make some progress. I have been very generous in giving way.

The Government are grateful to Members for raising these important issues, but, regretfully, we cannot accept the amendment. The amendment makes two key changes. First, it gives commissioners of other trusts affected by the recommendations of an administrator at a foundation trust the power to define essential services at those trusts. That would be cumbersome and impractical and draw the focus away from the trust in administration and undermine the need for recommendations affecting other providers to be “necessary and consequential”, which is something that my right hon. Friend the Member for Sutton and Cheam believes in and raised in Committee.

Secondly, protecting essential services gives the administrator their focus for the trust in administration; it is a critical part of the process. Asking commissioners at other trusts to define their essential services would incorrectly indicate an equivalence in the administrator’s role between the failed trust and other successful providers.

Clause 119 recognises the need to give other commissioners a clear role and a proper say. It already extends the existing requirement on an administrator at a foundation trust to obtain the consent for their recommendations from each commissioner of the failing trust, and also from each commissioner of any affected trust. NHS England support must be sought in cases where not all commissioners agree.

Let me be absolutely clear. Under subsections (3), (4) and (6), the commissioners who are asked to agree and draft the final TSA report already include commissioners from affected trusts. It may be hard to spot that in the clause, as it amends existing legislation.

Clause 119 also requires the administrator to consult other affected commissioners. He or she must publish a summary of the consultation responses and take them properly into account when making final recommendations. The Secretary of State or Monitor will need to be satisfied that the administrator has carried out their administration duties properly, including showing proper regard for the statutory guidance.

Commissioners of other affected trusts will therefore have every opportunity to make their views known. However, I would like to thank my right hon. Friend the Member for Sutton and Cheam for bringing the matter to our attention. The Government agree that it is important for other local commissioners to be able to protect their essential services. We will update the guidance to make it clear that the agreement of commissioners to the TSA report should include their agreement that essential services have been protected at other trusts, as well as at the failing trust, so that all local commissioners have an equal say, with NHS England arbitrating in the event of disagreement. Furthermore, I would like to invite my right hon. Friend to chair a committee of MPs and peers to consider the draft guidance and ensure that his concerns are properly addressed before the regime is used.

[Bob Stewart]

My disquiet stems from the fact that when the TSA was put into South London Healthcare NHS Trust there was no mention that it would go beyond its borders and into Lewisham. I do not think that was very clever. That is what worries me about the Government’s plans.

[Dr Poulter]

The spirit of the previous Government’s legislation was to look at the wider health economy when a trust is in extremis and has reached the point at which it is failing patients, either because of its financial failure or the direct effect that has on the quality of patient care. There then needs to be a wider look at the whole health economy. I know the Princess Royal university hospital in my hon. Friend’s constituency very well. I also know Lewisham hospital very well, having done some of my medical training there. They cannot be seen in isolation from King’s college hospital, Woolwich, Sidcup and all the other hospitals in the area, because they look after patients in that part of London as part of an integrated health and care service. When a hospital fails in that way, it has to be looked at holistically. It is a power of last resort, to be used when a trust is in extremis, not a routine power, which is why we have the TSA process set up by the previous Government.