Oral Answers to Questions

Clive Efford Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will, I am sure, know that an application for foundation trust status from the Royal Cornwall Hospitals NHS Trust is currently being considered by my Department. The trust is being assessed on whether it meets the quality, service, performance, business strategy, finance and governance standards required if a trust is to be an FT. Once the trust has demonstrated that it has met those standards in all other regards, the Department will ensure that any outstanding liquidity issues are resolved in time for the trust to be authorised as an FT. The process of assessing FT applications will ensure that any remaining debt carried by the trust when it becomes a foundation trust is affordable within the trust’s forward plans.

[Clive Efford (Eltham) (Lab)]

The chair of the South London Healthcare NHS Trust has written to the Secretary of State to correct inaccurate information given out by the Department of Health regarding the trust’s performance. [Interruption.] Instead of barracking me, would the Secretary of State—[Interruption.] Instead of shouting at me now, it is a shame that the Secretary of State did not meet the local MPs when he had the opportunity. Will he distance himself from the false information put out by unattributable sources in his Department, which will undermine the performance of the hospital and shows little respect for the health service workers who are working to improve services?

[Mr Burns]

If I can calm the situation down. [Interruption.] If the hon. Gentleman will just hush I will give him the answer.

National Health Service

Clive Efford Excerpts

Monday 16th July 2012 Commons Chamber

[Mr Simon Burns]

rose—

[Clive Efford (Eltham) (Lab)]

rose—

[Andy Burnham]

I will give way to the Minister one more time, and then to my hon. Friend the Member for Eltham (Clive Efford), but after that I must make some progress.

[Andy Burnham]

The Minister seems to equate removal of the Act with bringing back PCTs and SHAs. I do not have a problem with clinical commissioning, and I said as much during the Bill’s passage. I introduced it myself. I do not have a problem with clinical commissioning groups; my problem is with the job that they are asked to do, and the legal context in which they are asked to operate. We reject the Secretary of State’s market, and that is why we will repeal his Act.

[Clive Efford]

Clinicians in south-east London presented proposals for the reorganisation of our health care provision in “A picture of health”. It was all agreed by local commissioners, but when the Tories took office, they imposed a two-year delay that cost our health care trust £16 million a year—and that is the same trust that the Secretary of State has just put into administration.

[Andy Burnham]

This is what happened: when they came into government, they had a cynical policy of a moratorium, and they went up to Chase Farm hospital to announce it, saying, “There will be no cuts and no closures at this hospital.” They traded and touted for votes in that constituency for years on the back of that issue, and now that hospital is going to close. They delayed the reconfiguration and then they delayed the savings that came to the NHS. It was disgraceful, and people will have seen through it.

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[Andy Burnham]

I was prepared to make difficult decisions and be honest about them. I am not proposing the reversal of that decision and I note that clinicians in his area recently said how it had improved outcomes for his constituents. What I will not do—what I will never do—is go to marginal constituencies, as the Secretary of State did, and make false promises that I will reopen such units. The Secretary of State did that before the last election; no wonder he is looking shifty in his seat right now. He went to the hon. Gentleman’s constituency and said that he would reopen that unit. Has he done that? I do not believe that he has.

[Clive Efford]

On that very point about turning up in constituencies just before general elections promising to save A and E services, the Tories pledged to save 999 services at my local hospital, Queen Mary’s, Sidcup. They pledged to keep that A and E open—the Secretary of State did so himself. Where is the A and E?

[Andy Burnham]

I do not know how the Secretary of State justifies what has been done. Even in my own patch, Greater Manchester was going through a children’s and maternity services review and some constituencies were benefiting from the changes—Bolton, for example, was getting a bigger maternity unit—but some were not and this Secretary of State went both to Bury, where he said that he would defend the maternity unit, and to Bolton, for a photo call celebrating the new investment. If anything illustrates the sheer opportunism of the Secretary of State in opposition, surely that is the example that does.

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[Mr Burns]

No, I will not.

The motion speaks of the

“increasing number of cost-driven reconfigurations of hospital services”.

The reconfiguration of NHS services must always be led by a desire to improve patient care and patient outcomes. As lifestyles change, as needs and expectations grow and as technology develops, the NHS must respond. This Government are very clear that the reconfiguration of services is a matter for the local NHS, and that the best decisions are those taken closest to the front line and tailored to the needs of the local population. But, when making those decisions, it is imperative that the NHS carries the support of local people, patients, carers and clinicians.

The principle is enshrined in the four tests that my right hon. Friend the Secretary of State set out in 2010: all local reconfiguration plans must demonstrate support from clinical commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.

[Clive Efford]

rose—

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

rose—

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[Mr Burns]

The right hon. Member for Leigh equates the coalition agreement’s promise of a temporary moratorium on changes to hospital services, with a commitment to hold the NHS in a permanent state of suspended animation. The moratorium was needed to put a stop to the arbitrary reconfigurations that his Government instigated—reconfigurations that lacked the support of local clinicians, lacked a clinical evidence base and lacked basic democratic legitimacy. This Government and the Secretary of State have put that right.

Now I turn to another issue that the right hon. Gentleman raised and which is of considerable importance, given what has—

[Clive Efford]

rose—

[John Woodcock]

rose—

NHS Risk Register

Clive Efford Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

It is because we are clear that the reason he said that was that there was no mechanism available to Monitor in legislation for the maintenance of services and interventions. The Bill will mean that there is.

I sometimes think that the shadow Secretary of State has not actually read the Health and Social Care Bill. He keeps saying that this or that is in it, or that it does or does not do this or that, but for the first time since 2003, when his predecessor’s legislation stated that there should be a mechanism for dealing with hospitals that are failing, we are setting out a proper structure for the continuity of services. He says that it is just about de-authorisation, but it is not.

[Clive Efford (Eltham) (Lab)]

rose—

[Grahame M. Morris (Easington) (Lab)]

rose—

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[Mike Freer]

I will tell the hon. Gentleman what I did say. When I met GPs, I said that I would support putting patients first. Moreover, reform of the NHS was clearly specified in the Conservative manifesto on which I stood.

The previous Government sought to involve the private sector. Where was the risk register then? Was it published when the private sector was involved in the NHS? No, it was not. Will we get to see that risk register now? I doubt it.

Risk registers are, by definition, meant to explore everything that could possibly go wrong. They never make happy reading. The Secretary of State has already published more information than has ever been published before. He has already published relevant risks connected with the Health and Social Care Bill in the combined impact assessments, which consist of 400 pages of detailed analysis. The Opposition see the release of the risk register as simply an opportunity to cherry-pick the doomsday scenarios that it may contain. It is no more than a charter for shroud-waving. Every risk register contains such scenarios, and opponents would present them as fact.

I oppose the publication of risk registers because it would be impossible to pick and choose which were to be published and which were not. Once the Pandora’s box has been opened, it is open. The Opposition may argue that the publication of this risk register is in the public or the national interest. No doubt Department of Health risk registers examine what could go wrong, as in the case of other threats. What about threats relating to terrorism or outbreaks of infectious diseases?

[Clive Efford]

Will the hon. Gentleman give way?

[Mike Freer]

I have already given way twice.

There are clearly good reasons why the details of such threats should not be open to public scrutiny. Some might argue that their publication too is in the public or national interest, but we are not hearing that argument today; we are hearing only about this register, and not about the others. The Opposition’s stance is strong on opportunism and weak on intellectual coherence.

Let us look at their record in government. In 2009, when the shadow Health Secretary was Health Secretary, he refused a freedom of information request for publication of the Department’s strategic risk register. According to the Department,

“'a public authority is exempt from releasing information, which is or would be likely to inhibit the free and frank provision of advice or the free and frank exchanges of views for the purpose of deliberation'”.

There was also reference to the neutering of the free exchange of opinions between Ministers and advisers. That held then, and it holds now.

There is another issue, which was touched on by my right hon. Friend the Secretary of State. If the Department of Health is forced to issue all risk registers, what about other Departments? Will the Treasury have to release all risk registers involving the economy? Would that not cause financial havoc in the international markets? That explains why past Administrations have also refused to publish such documents. From a governance perspective, the Government’s stance is entirely right.

One of the problems of risk registers is that they are meant to be frank about what could go wrong. Any Member who has served on a project board will know how valuable such registers can be and how invaluable completely blank ones can be, and will also know that if the authors of risk registers are afraid to be open because of what might be misinterpreted, routine publication will cause them to become bland and anodyne and will render them useless.

The motion is simply posturing at its worst, and I will be voting “No” this evening.

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[Andrew George]

I am grateful for that intervention, because it plays into my next point, which is on my general concern about the nature of Opposition day debates. It is not that I think that Opposition parties should not have the opportunity to debate issues, but such debates tend to over-dramatise the political tribalism of this House. It is in the nature of government that when in government people tend to have to face up to and take unpopular decisions, whereas in opposition they tend to avoid them. Equally, on this issue, those in opposition tend to say that they would be more open, because they look at the matter from a different perspective and take the view that they would have more open government. When people come into government, they tend to err on the side of seeing good technical reasons for why they cannot engage in the process of open government.

[Clive Efford]

rose—

[Andrew George]

I will give way, although I am going to lose time.

[Clive Efford]

I shall be brief. This transition risk register refers specifically to the Bill, about which there is widespread concern. The register is unprecedented in that regard so, with due respect to the hon. Gentleman, his argument really does not hold.

[Andrew George]

I am cantering around the issues. I have signed the early-day motion, so I judge that disclosure is better than non-disclosure. However, I wish to make a further point about the kid psychology of this whole thing. We all tend to want what we cannot have and if we obsess about this issue, we might take our eyes off the ball of what the debate ought to be about. That brings us back to the point made by the former Secretary of State.

I ask the Minister who is winding up: when has the disclosure of such documents actually harmed Government public services? If we were given examples of where disclosure of information has actually harmed the delivery of effective government, we could begin to mount a case for trying to define the lines of where and when such documents should be published. On the basis of the debate so far, I am not sure that we have demonstrated that if we were given the new toy in this political playground—the publication of the risk register—it would necessarily improve the quality of the debate.

Of course, the main show, rather than the sideshow, is the Bill itself. I am concerned that if the risk register were to be published soon, and we were to have information that would perhaps help to change people’s minds and enable a more informed debate, it would not be possible to come to a considered conclusion that it would be best to withdraw the Bill because of the nature of the prism of the Westminster village. Given the virility contest in which such decisions are taken, the climbdown needed for a Secretary of State to withdraw a Bill such as this would be catastrophic both for himself and for the Government. So we end up continuing on with something that I believe could be catastrophic for the NHS—I have put my views in the public domain on many occasions on this issue.

The right hon. Member for Leigh (Andy Burnham) may want to win over Liberal Democrats, but describing us as “spineless” will not necessarily get many of us into the Lobby with him. If he does not want to contaminate his party with people he believes are so infected with such a disabling condition, I am not sure that it will help.

Health and Social Care (Re-committed) Bill

Clive Efford Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

I do not recognise such a scenario and in any case there will be no transfer of NHS-owned organisations and the estate and property of such to the private sector. We are not engaging in privatisation, so to that extent the question does not arise.

I must also make it clear that the implication of the proposals I have just described—

[Clive Efford (Eltham) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

The implication of these proposals is that we are not continuing with our previous proposals to have a system of prior designation. We are also withdrawing our proposals to apply insolvency law, including the health special administration procedure, to foundation trusts, so I hope that Opposition Members will not press amendments 29 and 30.

I hope that that explanation of the purpose of the substantive group of Government amendments will help the House. In a moment, I shall turn to some of the additional amendments that have been presented by other colleagues.

NHS Future Forum

Clive Efford Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I can assure my hon. Friend that I know his local GPs, and that they want to work with their professional colleagues across their area and to get on with that now. We will continue to be able to delegate commissioning responsibilities to all commissioning groups who are ready to do that; if they show that they are ready, we can give them the capacity to do it through existing NHS structures.

[Clive Efford (Eltham) (Lab)]

This is not a U-turn; it is a body-swerve around the Liberals. The Secretary of State has spent the last year telling us that cherry-picking for profit in the NHS will not be possible under his Bill, yet today’s report has told us that he must take action to prevent such cherry-picking. Does the Secretary of State understand that this is now an issue of trust, and that nobody trusts him on the NHS—made in Britain by Labour, stolen by the Tories, and given away to his fat cat friends?

[Mr Lansley]

I will not attempt to compete with the hon. Gentleman on any driving analogies, but we have been clear that we will not countenance cherry-picking against NHS providers. The Future Forum has made recommendations on that, but they are not all to do with the Bill: for example, the processes I described of using a tariff lie outside the scope of the Bill. The Future Forum is making recommendations, and we are responding positively to them.

Future of the NHS

Clive Efford Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

The point about the Health Secretary’s legislation is that it allows consortia to outsource in whole the job of, not the responsibility for, commissioning. He made the point that the consortia are public bodies, but they meet none of the standards of public governance. They can meet in private. As the right hon. Member for Charnwood (Mr Dorrell) has said, that serious job should be done by properly constituted and governed public authorities, but that is a loophole in the Bill.

[Clive Efford (Eltham) (Lab)]

Like my right hon. Friend, I heard the Prime Minister and Deputy Prime Minister over the weekend say that there will be changes to the Bill. However, every Government Member who has intervened has defended the position in the Bill. Will we see changes as a result of pausing, listening and reflecting, or not? Will the Liberal Democrats have a spine tonight and vote with the Opposition to get changes to the Bill?

[John Healey]

My hon. Friend puts the position and the challenge, especially to the Lib Dems, very clearly. The challenge to Conservative Members is this: they must recognise that the Prime Minister made the NHS his most personal pledge before the election. People wanted to believe him, but in just one year the NHS has become his biggest broken promise. My hon. Friend mentions the pause. In our Opposition motion in March, we urged the Government to

“pause the progress of the legislation in order to re-think their plans”.—[Official Report, 16 March 2011; Vol. 525, c. 374.]

The Health Secretary dismissed that, but he has now been told to do so by the Prime Minister.

However, many of the signs point to the Prime Minister’s “pause to listen” being a sham. Just one week after the announcement, and in fact on the day that the Health Secretary received that historic vote of no confidence at the Royal College of Nursing, the NHS chief executive wrote to NHS managers to tell them that

“we need to continue to take reasonable steps to prepare for implementation and maintain momentum on the ground”.

The House is used to pre-legislative scrutiny, but not pre-legislative implementation.

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[Clive Efford (Eltham) (Lab)]

I must confess to being somewhat confused about where we have got to with the Bill. I have been here for 14 years and I cannot recall a Bill being halted after it had been through Committee so that we could go back and consult the public. I will be corrected by Members who have been here longer than me, but I cannot remember anything like this extraordinary situation.

Yesterday, I listened to the Deputy Prime Minister on the “Andrew Marr Show”. He said:

“Let me stress this, it’s not a gimmick, it’s not a PR exercise. We will make changes, we’ll make significant and substantive changes to the legislation”.

We have not heard any of that tonight. No one has got up and said, “We are listening,” or, “We are pausing,” or “We are reflecting and we are going to see substantial changes to this Bill.” The Secretary of State is in his place: I would like him to intervene on me and tell me that in relation to GP commissioning, the full £80 billion will be transferred to GPs, as he has frequently stated it would; that they will be in charge of commissioning and that we will not see that altered in any significant way as a result of the interventions of the Prime Minister or the Deputy Prime Minister. Members of the Government are trying to say that they are listening and that they are not responsible for all this, but I have here the White Paper that was published back in January, the foreword of which was signed by the Prime Minister, the Deputy Prime Minister and the Secretary of State for Health. They all signed up to it, but all of a sudden we are back to pausing, reflecting and listening.

What or who are we listening to? We have heard from the Secretary of State tonight that there are no cuts in the NHS, but let me tell hon. Members the story of Mrs Bell, a constituent of mine who was referred by her GP to a consultant last spring about cataract operations. She received the first operation within 18 weeks, and when she went back for a second consultation about the other eye she was referred for another operation. After 18 weeks, she rang the local health care trust to say that she had been waiting for her cataract operation for 18 weeks, but she was told that that was no longer a deliverable target. She ended up waiting more than 26 weeks for that cataract operation, so no one can tell my constituents or anyone else that we are not seeing cuts to the NHS and longer waiting times for patients.

What is fundamentally wrong with the Bill is that it places the market at the head of commissioning and planning services. The coalition document said that the coalition was going to introduce some element of democracy into primary care trusts, but PCTs got demolished as part of the proposals. My local PCT has been absolutely decimated, because although the Bill has not gone through Parliament yet, people are acting on it: they are voting with their feet and they have all gone. Currently, my area has no one who is responsible for the oversight and planning of our local health care services. Moreover, no one who will ultimately be accountable to local people is responsible for planning local services. All of that has been frittered away; it has disappeared. What we need is some form of democratisation of the commissioning process so that local people can know quite clearly who is accountable and who is not.

Tonight’s vote presents the Liberal Democrats—after we have paused and listened and reflected and after all they have said over the weekend about changes to the legislation—with an opportunity to send a message to the Government. This morning, the hon. Member for North Norfolk (Norman Lamb), the Parliamentary Private Secretary to the Deputy Prime Minister, said on the “Today” programme that there will be significant changes to the Bill. If the Liberal Democrats want to send a message to the Government, they should join the Opposition in the Lobby tonight and send the message that the Bill has to be changed. But I will tell them what will happen when it comes to Third Reading. The Whips will get to them, they will be as spineless as ever and they will go through the Lobby defending the Bill’s Third Reading—

[Madam Deputy Speaker (Dawn Primarolo)]

Order.

Oral Answers to Questions

Clive Efford Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

I am glad to endorse my hon. Friend’s congratulations to the staff and team at Warwick hospital. I hope to have an opportunity to visit that hospital at some future date. Across the NHS, we are setting out not least to increase productivity and efficiency, stimulate innovation, reduce administration costs and put more decision-making responsibility into the hands of those who care for patients, which the Labour party failed to do.

[Clive Efford (Eltham) (Lab)]

How can the Secretary of State convince people that he is protecting front-line services when a flagship Bill such as the Health and Social Care Bill is in such disarray? While he is pausing and listening and reflecting on that Bill, will he also consider whether the House will have a further opportunity to consider his reflections, because we are through the Committee stage? Will there be another Committee?

NHS Reform

Clive Efford Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

Yes, I can. Under the coalition Government, in mid-Essex there has been a 3.2% increase in cash for the NHS this year compared with last year. Not only that, but more of that money will, as a consequence of our changes, get to the front line to deliver improving services for patients.

[Clive Efford (Eltham) (Lab)]

“No decisions about us without us” could apply to every single person who works in the NHS who has been telling the Secretary of State that these are reckless changes. Throughout the country changes are taking place. Now he says that he is going to be listening. If so, we can anticipate some more changes. Will he therefore instruct everyone in the NHS who is currently restructuring on the basis of the Bill to stop that restructuring until we know exactly what the Government intend to do?

[Mr Lansley]

No, I will not, because we are very clear about the strategy and the principles of the Bill. We are equally clear that now we have the opportunity to work with the developing GP pathfinder consortia, the health and well-being boards in local authorities and the wider community to ensure that the implementation of the Bill and its structure support those developing organisations.

NHS Reorganisation

Clive Efford Excerpts

Wednesday 16th March 2011 Commons Chamber

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

The Labour motion is interesting. I will ask the House to reject it, but it is an interesting motion. The first half of it accepts the principles of our reforms—it even does so in the same terms in which we have expressed them—but in the second half it goes on to say, “Not yet. Don’t make us do it yet.” Labour Members are turning their backs on the change that we need in the national health service and even on the policies they pursued in government.

But it is time for change. The public agree—65% of adults in England think that fundamental changes are needed in the national health service. The need to improve results for patients demands it. The need to empower clinical leadership demands it. The need to cut bureaucracy and invest in front-line care for patients demands it. As a coalition Government, we do not shirk our responsibilities. We have been absolutely clear that the NHS will remain free at the point of need, paid for from general taxation and based entirely on need and not on the ability to pay.

Those values are not, and never will be, threatened by this Government. The Health and Social Care Bill will not undermine any of the rights in the NHS constitution. It is for those same reasons that we, in a coalition Government, are protecting the NHS in the life of this Parliament by increasing NHS funding by £10.7 billion.

[Clive Efford (Eltham) (Lab)]

Will the Secretary of State distance himself from the comments of Dr Charles Alessi, a GP alleged to have been one of the architects of GP commissioning in this Bill and one of the people invited to No. 10, who is of the opinion that too many people in his area are receiving treatment for macular degeneration? Is that not rationing services and nothing whatsoever to do with providing them on the basis of clinical need?

[Mr Lansley]

All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.

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[Mr Lansley]

No.

[Clive Efford]

rose—

[Mr Lansley]

No. I have given way to the hon. Gentleman.

Only yesterday—

Health and Social Care Bill

Clive Efford Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

The accountability in the NHS will be for the quality of the service being provided. The hon. Gentleman may not have agreed with the last Labour Government on this, and perhaps many in the Labour party are now changing their view on what was pursued by that Government, but it was that Government who introduced and encouraged a policy of “any willing provider”. In 2003, Alan Milburn said:

“If I can get a private-sector hospital to treat an NHS patient, then for me the person remains an NHS patient.”

Everybody in the NHS who provides NHS services will be accountable through the—[Interruption.] The money will follow. The Chair of the Public Accounts Committee is here. Where public money goes, accountability for its use will follow.

[Clive Efford (Eltham) (Lab)]

rose—

[Hugh Bayley (York Central) (Lab)]

rose—

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[Jeremy Lefroy (Stafford) (Con)]

rose—

[Clive Efford]

rose—

[Mr Lansley]

I give way to the hon. Gentleman. I will give way to my hon. Friend the Member for Stafford (Jeremy Lefroy) in a moment because I referred to Staffordshire.

[Clive Efford]

The right hon. Gentleman will know that the Bill introduces European competition law into the national health service, and removes the existing protection once and for all. His Government have just taken the decision to put billions of pounds into stopping Irish banks failing. If a local hospital fails under the new market arrangements, will he step in and save it?

[Mr Lansley]

Time does not permit me to explain the extraordinary ignorance of that series of points. First, the Bill sets out that the regulator will have a responsibility to establish a failure regime. In 2003, when the predecessors of those currently on the Labour Front Bench took the health legislation through the House, they said that they would introduce a failure regime, to be implemented by Monitor, in legislation. They never did so. At the moment, there is therefore no proper failure regime.

Secondly, European competition law—indeed, competition law—applies in this country. A body was established in the national health service under the previous Labour Government called the co-operation and competition panel, the express purpose of which was to apply competition rules in the NHS. To that extent, all the Bill will do is to ensure that the rules that already apply are applied fairly, consistently and transparently across all providers.

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[Clive Efford]

Will my right hon. Friend confirm that in order to shoehorn private enterprise into the NHS, the regulations are being written to add a 14% premium into the tariff for private sector companies that will be tendering for work?

[John Healey]

My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.

Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.

If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.

Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.

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[Clive Efford (Eltham) (Lab)]

This is a very dark day for the future of our national health service, particularly for those who have spent most of their political lives campaigning for and supporting the NHS. Some of us remember what 18 years of Conservative government did—the hospital closures and continually increasing waiting times that patients had to endure. One of the first cases that came through my door when I was newly elected to Parliament was that of someone who had been waiting 18 months for open-heart surgery. His wife came on his behalf, pleading for something to be done. I am pleased to say that he was treated under a Labour Government and that he is still alive today.

In contrast, this is a good day for those who have always hated the national health service. I remember a former Tory MP, Matthew Parris, who became a journalist, going on TV at around the time of the 1997 election and being asked, “What is it about the Conservatives and the NHS?” He replied, “It is quite clear—they hate it.” They hate the idea that they pay taxes and that the “undeserving poor” get equal treatment in the NHS, and they do not accept that people should be treated according to clinical need. That is why they continually chip away at the NHS. I do not blame the Tories, because they are just doing what Tories always do to the NHS, but when people went to the ballot boxes and voted Liberal Democrat in the last general election, they did not vote for the destruction of the NHS.

Many Government Front Benchers have campaigned against hospital closures, but the impact assessment for the Bill clearly states that Members of Parliament and local councillors should not be allowed to influence any decisions about hospitals in future. The Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), looks surprised, but that is in the impact assessment. Did she not read it? No wonder the Government did not publish it until last Thursday. It says that anyone on the Government Benches who campaigned at the last general election to keep a hospital open will be prevented from influencing decisions in the future. In order to secure a market and prevent it from being unduly influenced by political interference—in order to create a fair marketplace—politicians will be denied the opportunity to influence what is going on. That is in the Bill and the impact assessment. Before any Liberal Democrat votes tonight, I urge them to check that impact assessment, because if they do not, they will be voting for something without appreciating what is coming down the road.

I fully support the idea that GPs will be champions on behalf of their patients, but I am sure that the measures will be a bit of a curate’s egg in that respect. Howard Stoate, a former colleague of ours, supports GP commissioning and I have no doubt that if I were his patient I would be very pleased to have him as my GP, but unfortunately not every GP is a Howard Stoate. The issue with what is going on and what is being changed here is that GPs will not perform in the same way across the board. We saw that with the Tomlinson review and GP commissioning before—a lot of them became property developers. They top-sliced capital money, developed their properties, sold them off at a profit and moved down the road. We have seen all this before.

[Several hon. Members]

rose—

[Clive Efford]

No, I am not going to give way.

What about the idea that there will be patient choice and that patients will have some idea of where to go? Are we going to get all the information about private sector providers? Are they going to publish their performance data in the private sector when patients are making up their minds whether to use them or not? I suspect that we will get what we got before with these sorts of changes—commercial confidentiality; we will be told, “We can’t possibly tell you that because that would harm our performance in the marketplace.” That is what we got before and I do not doubt that we will get it again.

Let me address the comparisons that we have heard from Ministers.

[Several hon. Members]

rose—

[Clive Efford]

Members can just sit there and listen. [Hon. Members: “Give way!”] They put this ridiculous Bill up—they can sit there and listen.

The comparisons that we have had from the Government about performance on heart disease and cancer involve the selective use of statistics to try to prove their point. The Appleby review clearly states that on current trends, by 2012—[Interruption.] I am not reading my notes; I do not know whether the Minister has noticed. Appleby states that by 2012 this country’s performance in relation to a number of cancer treatments will exceed that of France, which in 2008 spent 28% more than us, as a proportion of gross domestic product, on health. We have only just reached the European average in terms of expenditure on the national health service and, as other hon. Members have said, it is time to let the NHS bed down. The time for change is not now. We should allow that expenditure to have the effect—