Mental Health (Approval Functions) Bill

Dan Byles Excerpts

Tuesday 30th October 2012 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Opposition do not oppose the Bill. We are aware that much of this activity took place under a Labour Government, and we are anxious to work in the most co-operative way possible to resolve the situation. However, I would do the House a disservice if I did not set out the in-principle objections to retrospective legislation of this kind.

I should like to quote someone whom Government Members may take more seriously than some of us. In the “The Road to Serfdom”, Hayek said of the rule of law:

“Stripped of all technicalities [the rule of law] means the government in all its actions is bound by rules fixed and announced beforehand—rules which make it possible to foresee with fair certainty how the authority will use its coercive powers in given circumstances, and to plan one’s affairs on the basis of this knowledge.”

I shall set out objections to retrospective legislation, because despite the urgency of the situation and the problems that might arise if it were not introduced, we should recognise that it is a very serious matter to introduce retrospective legislation of this kind. The Opposition, as my right hon. Friend the Member for Leigh (Andy Burnham) said, were a little surprised that the Secretary of State for Health did not open the debate.

If retrospective legislation is undesirable in principle, it is particularly undesirable when it concerns the liberty of the subject. There is no precedent for retrospective legislation on such matters. We are dealing with the mentally ill and the sectioning of people under the Mental Health Act 1983. Due process is even more important in relation to issues under that Act than in relation to other matters of criminal justice, as we are dealing with vulnerable people who are not in a position to advocate for themselves. Due process is not less important in relation to Mental Health Act matters; it is more important.

I urge the House to pause for a second and see the situation from the point of view of the mentally ill, their families and their supporters. For people engaged with mental health legislation, the process may appear Kafkaesque and labyrinthine. They now know that 5,000 people—perhaps more—were sectioned, strictly speaking, illegally, which can only cause unhappiness and uncertainty. As hon. Members have said, it may even affect the condition of those people.

[Dan Byles (North Warwickshire) (Con)]

I do not disagree with anything that the hon. Lady has said, but I should like to clarify something. Is she basically saying that she supports what the Government have done, but is putting on record the fact that the measure must not be seen in any way as a precedent? This is an exceptional and unique set of circumstances. Is that effectively what she is saying?

[Ms Abbott]

I have been a Member for 25 years. I have never seen retrospective legislation of this kind. Although we support what the Government are doing, we do not want it to be seen in any way as a precedent; nor do we want it to be thought that, because the measure relates to the Mental Health Act, it is less significant than if it were a broad criminal justice concern. That is the point that I want to put on the record.

As I have said, for patients and their families, the mental health system may appear labyrinthine and Kafkaesque at the best of times. Now they find that for a long period—some of it under a Labour Government—people were being sectioned without proper due process. Ministers have said, both today and yesterday, that this is a technicality, but due process means that people should abide by the technicalities. Only in that way can we defend the liberty of the subject, and only in that way can the subject have any recourse. If we do not abide by the technicalities and if the rule of law does not apply, where do our constituents and other ordinary people turn if things go wrong?

Ministers have made a series of assertions. They have said that no patient has been wrongly detained or received care that was not clinically appropriate. They have said that no doctor was unqualified to make the decisions, and they say that urgent action is being taken to correct the situation. But I would be interested to hear from Ministers whether there has been an individual case review of these cases. How can they assert that no patient has been wrongly detained or received inappropriate care if the Government have not reviewed each case individually? How can Ministers assert that no doctor was unqualified to make the decisions if they have not reviewed each case individually?

I am not raising these issues to stop what I understand is an urgent process, but it would not be right for the House to railroad the legislation through without paying attention to the individuals and the individual cases involved. If there has been no individual case review, the question raised by other hon. Members whether the Bill will stand up to judicial review comes to the fore. Is the Minister in possession of robust, irrefutable evidence to show that none of the more than 5,000 patients detained by the approximately 2,000 not properly approved doctors was subject to clinically inappropriate detention or hospitalisation?

Will the families and carers of those individuals be advised of the situation and given an opportunity to raise any concerns that they may have? When a relative is detained under the Mental Health Act, the question whether that is appropriate can be one of the most difficult and traumatic questions that a family has to face, and to dismiss the lack of due process as a mere technicality, as Ministers have come dangerously close to doing, is not fair to those individuals and their families—our constituents.

Although I accept that the doctors concerned have acted in good faith, I hope the Minister will agree that we are dealing with a highly vulnerable group of individuals—the patients and their families—and they need to have absolute confidence in the Government’s response. We understand that introducing urgent legislation is part of offering such reassurance. It will protect vulnerable patients from a potentially exploitative situation in relation to what are commonly called ambulance-chasing lawyers, but when their relative is taken away from them, people also want to know that this is not a mere rubber-stamping process. I have heard nothing so far that would reassure me, if I were the mother or a relative of one of the people detained under a defective process, that Ministers do not regard this as a mere rubber-stamping process and that all the Bill does is alter in some technical way the nature of the rubber stamp.

My right hon. Friend the Member for Leigh made the point that we need to move forward with a very different attitude to mental health. We need to look for parity of esteem between mental health and physical health, but in this matter, in relation to the liberty of the subject, we also need to look to parity of esteem when someone’s liberty is taken away under the Mental Health Act and under broader criminal justice legislation. If people had been held in prison and there had not been due process, it would not be good enough to railroad through retrospective legislation in an afternoon in the House of Commons. There would be much more uproar.

We want to impress upon Ministers that we must take seriously the liberty of people detained under the Mental Health Act and demonstrate that we are doing so. A number of questions have been raised by hon. Members on Second Reading, and we hope that the Minister will be able to answer them. I thank right hon. and hon. Members who have taken part in the debate. As I said earlier, I hope the Government will try to involve the family and carers of those affected more closely in the process of bringing clarity. I hope that the Government will seek to remove any uncertainty and will explain to them what they can do to seek redress.

Like my right hon. Friend the Member for Leigh, I commend Ministers for their attempt to move quickly on a very difficult issue. We want to offer the Secretary of State any assistance that we can as he seeks to answer questions from patients, families, carers and the wider public, but we say to him that retrospective legislation is very serious. It cannot be dismissed as a technicality. The liberty of the subject is, so to speak, the ground zero of parliamentary democracy in this country. It cannot be dismissed as a mere technicality. Sadly, I do not believe that the debate this afternoon will be the last that we hear on the matter. It is extremely important that those of us who are in the House this afternoon tease out the answers to the questions that have been put.

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[Mr Hunt]

The answer to the right hon. Gentleman is yes. I will now return to the specific questions asked about the Bill.

The hon. Member for Southport (John Pugh) talked about the important issue of discrimination—that is, whether we are behaving differently because these patients have a mental illness. Removing discrimination does not mean treating everyone exactly the same. In fact, we will remove discrimination in the mental health field by better understanding the vulnerabilities and needs of people who have serious mental health problems, and that might mean treating them differently to account for that. The hon. Gentleman is absolutely right to say, as was the hon. Member for Hackney North and Stoke Newington (Ms Abbott), that important human rights issues need to be considered. I want to reassure him that, even in the four SHAs where the technical irregularity in the approval of doctors arose, the criteria were as rigorous as those used to make the clinical assessment that it was necessary to detain someone under the Mental Health Act. The same quality of expert advice was drawn on in order to make those decisions.

The right hon. Member for Oxford East asked why we are not limiting the legislation to the four SHAs where we have identified this technical irregularity. That is because we do not know at this stage whether the problem may have predated the establishment of SHAs—we should remember that these powers go back to the Mental Health Act 1983—and therefore, to make sure that we deal with the problem in its entirety, it is better to include the whole country in the legislation lest we find at a later date that the problem had existed in other parts of the country, perhaps prior to the foundation of SHAs.

On human rights, I have signed a piece of paper saying that I believe that the Bill is compliant with the European convention on human rights. I did that on the advice of Government lawyers and of the Attorney-General. The Attorney-General believes that, were a case to be brought now, people would be entitled only to nominal compensation because this is a technical, not a substantive, irregularity, and it is therefore not, on this occasion, a breach of people’s human rights to pass a law retrospectively.

The hon. Member for Arfon (Hywel Williams) asked why this has taken so long—why, for example, the Mental Health Commission did not identify the problem in its years of existence. That is a very important question. I cannot pretend that I have the answer now, but I want Dr Harris to look into that issue in enormous detail because I want to know whether there is a risk that other errors, similar or related, might exist in other parts of the system. The House needs to understand much better whether we should be concerned about that and whether the right governance procedures are in place.

The hon. Gentleman mentioned advocacy. As he will know, all patients have a right to an independent mental health advocate, but that process has not always worked as well as it should. I want to use the opportunity of the transfer of those responsibilities from primary care trusts to local authorities to make sure that we have proper procedures in place so that people really do get the advocacy support that they need.

Let me confirm to the hon. Gentleman—we received this piece of information as my hon. Friend the Minister was speaking—that someone approved in one SHA is able to practise in other SHAs. That is partly why the legislation needs to be UK-wide. We have had a lot of discussions about this with doctors’ representatives, particularly the Royal College of Psychiatrists. I do not believe that there are any implications for the second doctor or the social worker, but if I receive advice to the contrary I will write to him to let him know.

I think that I have covered most of the points raised by the hon. Member for Wolverhampton North East. She asked what is going to happen when the SHAs are abolished. We will be asking Dr Harris to address that when he carries out his independent review.

Finally, I turn to the hon. Member for Hackney North and Stoke Newington and her important comments about the seriousness with which we must treat any retrospective legislation. She referred to what Hayek said about that, with which I wholeheartedly agree. I did not think that we would be agreeing across the Dispatch Box about Hayek, but there it is. She made the important point that due process is about respecting technicalities, so we cannot brush it aside. That is why this legislation is necessary. A failure of due process—a failure to observe technicalities—puts us in an extremely difficult situation where ordinarily we would want to say that due process should be observed in all circumstances and that we should not pass retrospective legislation on that. In this particular case, however, it would have been against the clinical interests of 5,000 highly vulnerable people were we simply to consider that single legal perspective; the broader clinical perspective needs to be recognised.

The advice that I received from Professor Sir Bruce Keogh, the medical director of the NHS, was very important in persuading me that we needed to take the route of emergency retrospective legislation. He said that the alternative, which was to go through all 5,000 people and redo the entire sectioning process now that all the doctors have been properly validated, presented serious clinical risks to those individuals. It is a very difficult matter. As the hon. Lady and I are trading political thinkers, perhaps I could refer her to Isaiah Berlin and say that sometimes important moral principles are not totally consistent with each other. This is one of those occasions, and we have to weigh her very important points about the need to avoid retrospective legislation, even on technicalities, against the clinical interests of a highly vulnerable group of people.

[Dan Byles]

In a previous life, I sat on the board of a Mental Health Act scrutiny committee in a west midlands mental health trust. Does my right hon. Friend agree that this retrospective change does not in any way undermine the fact that every single one of the patients he has mentioned has been through a very robust system of checks and balances throughout the sectioning process in order to be sectioned, and then while they are sectioned, and has access to a very robust appeals mechanism that the Bill in no way undermines?

[Mr Hunt]

My hon. Friend is absolutely right. The key point is that those patients are free to challenge any element of the clinical decisions made as part of that very thorough process. This proposed law is about the technical irregularity only, and it is precisely because of the legal risks associated with that irregularity that we think it is necessary, in the interests of those 5,000 people, to enact this Bill.

EU Working Time Directive (NHS)

Dan Byles Excerpts

Thursday 26th April 2012 Westminster Hall

[Kate Hoey (Vauxhall) (Lab)]

I, too, pay tribute to the hon. Member for Bristol North West (Charlotte Leslie) for her tireless work on this issue. I was pleased to be able to add my support to help secure the debate. It is a pity it is not taking place in the main Chamber, but it is great that we are having it and it shows to the Government the level of concern. Many hon. Members wish to speak, so I will be brief.

I come here not as a medical practitioner or as someone with any real medical knowledge, but as someone who cares deeply about the NHS and patient care. The hon. Lady outlined the difficulties very clearly, and in detail. We will hear many examples of what is wrong with the EU working time directive and its application to the NHS. We have to remember right at the beginning that the NHS is not a tick-box system of bureaucracy; it is about the care of patients, and the care of patients is in the hands of the people who work in it. If we allow the standards and the professionalism of our NHS work force to deteriorate because of the directive, we will leave a legacy that, in many years to come, we will look back on saying, “How could we have let that happen?”

I am privileged to have a great teaching hospital—Guy’s and St Thomas’, which is very near this place—in my constituency. A tremendous amount of effort has gone in to ensure that patient care is at the centre of everything that happens there. A terrific amount of work was done by the previous chairman, Patricia Moberly, to ensure that, fundamentally, everything that happens in the hospital is about patient care. It does not just serve its local community of Lambeth, but the whole of London, the whole of the country and patients from all over the world.

Understandably, the trust has implemented fully the EU directive. It is not, as was made clear to me, in the business of breaking the law. However, I have had many discussions about the directive, and the medical director of Guy’s and St Thomas’ told me that, despite doing everything possible to utilise more consultant presence out of normal working hours, and making every hour and minute count while a doctor in postgraduate training is at work,

“We are still left with a rigid template which is now seemingly outdated and needs revision for professional training.”

Many points have been touched on, but he raised the specific issue of the 13-hour shift limit leading to multiple handovers in a 24-hour period. He suggested that even an extension to 15 hours on weekdays, with appropriate compensatory time off later, would deliver a service with better continuity of care.

The medical director also raised the following important points:

“Many doctors in postgraduate training live in other towns and cities due to the rotational programmes of hospitals involved in their training. At weekends with 12 hour shifts, and with limited public transport services, especially on Sundays, there is more exhaustion from difficult commutes and two or three 12 hour shifts across a weekend rather than doing 1 X 24 hour shift with a better work life balance. We find that doctors try to re-organise their rotas to do this but we advise them that the EWTD does not allow this.

Doctors in craft specialties have fewer cases in their log books and less experience before gaining the certificate of specialty training than before. Perhaps they should be allowed to be with their consultant in an apprenticeship observer role to enable further exposure without being the provider of care to a patient beyond their…allowance.

Doctors in post graduate training should not feel that they are not allowed in the hospital beyond 48 hours. They should feel enabled to be in a learning environment—

and be able to—

“develop as a professional. Patient care is a 24 hour activity and EWTD has led to fewer doctors being in the hospital out of normal, working hours. This is inconsistent with activity in hospitals going up all the time, at all times.”

That is the formal response from my wonderful hospital. There are many other things that they would not want to put down on paper or read out in the Chamber, and I can understand why. From talking to many doctors, both training doctors and doctors with more experience, we know that what is actually being said is more serious than what is being said officially. It is much more stressful for many doctors to work in those patterns.

One close friend of mine who is a young doctor says that in the old days—I am sure we all remember the old days—a firm of doctors would be responsible for their patients pretty much all week, and on call on top of that. That meant good continuity of care that benefited patients and contributed to training. Doctors could see whether or not their treatment had worked. Now they have lots of zero days that interrupt the working week and mean that the teams are smaller day to day. It is rare for more than two to work together. That means that patients are seen by different people every day who do not know their case. They have repeatedly to answer the same questions, and getting things done takes longer because they do not know who has actually asked for something, perhaps earlier that day.

[Dan Byles (North Warwickshire) (Con)]

Quite rightly, hon. Members are very concerned about the impact on patient care, but is the hon. Lady aware of any work that has considered the financial cost of this regulation to the NHS?

[Kate Hoey]

We do not have to be GCSE standard—I have more than GCSEs, incidentally—to work out that it clearly costs more, because more and more locums have to come in, and extra people have to come in from abroad. Like agency nursing, that costs much, much more. I can never understand why, instead of bringing in agency nurses and paying more, we cannot have more nurses. The cost is a huge factor and it is going to get worse. With reductions, people will have to be more careful, and this will be a big issue. It is not good for doctor training—they cannot do their job properly and it is more stressful.

Nobody will admit that there is a huge amount of fiddling of figures going on. The only way that people in charge know that they are perhaps going to save people’s lives is to fiddle the figures and allow people to work outside the law. That is absolutely not trying to encourage that kind of behaviour in the NHS. I do not blame people for doing that, but it is a direct result of how we have got ourselves into this situation.

The Government are apparently saying that they are working urgently with Europe. I do not want to turn this into a debate on Europe. I think most hon. Members know my views on that. No matter how hard or urgently the Minister is working in Europe—I know what a good Minister he is—Europe’s idea of urgency and ours are a long way apart, so we have to find another way. Ultimately, as the hon. Member for North Antrim (Ian Paisley) said, this is about getting to the root of the issue. We live in an independent country and what we do in our hospitals and our NHS service should not be decided by bureaucrats in Brussels, with Governments misguidedly signing up to all sorts of things that the people of this country have never had any say in.

I will go back to what I say in every debate on Europe: it is time for the people of this country to have a say on what they feel their relationship with Europe is all about. An important part of doing that is to get the European working time directive changed, so that we can honestly say that we parliamentarians have done our bit to ensure that patient safety is improved and made better than it will be if this continues.

Health and Social Care Bill

Dan Byles Excerpts

Tuesday 13th March 2012 Commons Chamber

[Nicky Morgan]

That could be the voluntary sector or the community sector. They are all private. If someone has a physio appointment, it could be with a private provider. At the end of the day, we want the best care for patients and constituents. That is what we all want.

[Dan Byles (North Warwickshire) (Con)]

The hon. Member for Easington (Grahame M. Morris) will be aware that the George Eliot hospital is on the edge of my constituency and serves my constituents. There are six people on the shortlist of people it is talking to—six people who have asked to be spoken to. It is wrong to imply that the George Eliot has gone out and spoken to only two private providers. The rest are all NHS providers.

[Nicky Morgan]

I am grateful to my hon. Friend for clarifying that.

The shadow Secretary of State talked about trying to be constructive. I am unclear whether he supports his own motion. Is he calling for the Bill to be dropped or for a conversation? This reflects the position of the Royal College of General Practitioners, which says that it now wants to work with the Government to implement the Bill, having previously opposed it. That is because the people in the NHS are beginning to recognise that implementation is critical if we really care about patient care and service users. There has been talk about how people in the House have stopped listening. I suggest that it is the Opposition who have stopped listening. I am fed up with receiving repeat e-mails. When I reply, making this point and trying to engage in a debate, all I get is another standard e-mail telling me about privatisation and how the NHS will not exist in its current form. That is not correct and not fair on the patients who rely on the NHS.

As my hon. Friend the Member for South West Bedfordshire said, implementation is already happening in many parts of the country, and that is to be welcomed. In Leicestershire, I have three excellent clinical commissioning groups and a health and wellbeing board being set up. I salute the public health professionals in Leicestershire who are working hard on implementation, the secondary care providers, the patient participation groups and everybody else who has taken part. The trouble is that implementation is being hampered by this ongoing political debate. I have a real feeling of groundhog day every time I come in and speak on this. We are going round and round in circles, and I repeat that the people who are missing out are patients and service users. Loughborough has taken the difficult decision to move our walk-in centre, but the GPs have taken that decision, and although I did not agree with it, they are clear that it will result in better urgent care services, and they are spending more money on them. I am willing to trust their judgment.

Members want to talk about the vote of the RCGP. It is interesting to note that out of 97,000 professionals, only 4,700 have taken part in the debate on the Bill. That should tell us something. We need to get on with the Bill now.

Health and Social Care (Re-committed) Bill

Dan Byles Excerpts

Tuesday 6th September 2011 Commons Chamber

[Debbie Abrahams]

I thank my hon. Friend for that contribution.

[Dan Byles (North Warwickshire) (Con)]

What does the hon. Lady say to Professor Stephen Field, who was the chairman of the independent NHS Future Forum? He told the Bill Committee:

“When we spoke to the Government and…a lot of senior staff at the Department of Health…we did not, at any time, pick up any feeling that anyone wanted a free open market where people could come in and privatise the NHS, as some people have said in the press.”––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 15, Q26.]

[Debbie Abrahams]

I would be happy to forward to the hon. Gentleman a British Medical Journal article that reproduced in full the concerns of health care professionals that were not included in that account. Unfortunately, there is an element of bias in how they have been reported.

--- Later in debate ---

[Frank Dobson]

In fairness, I think that given the accuracy of the present Government’s aim, if they tried to rubber-stamp something they would probably miss.

[Dan Byles]

In view of the speech that the right hon. Gentleman is making and his definition of a “proper Conservative”, I wonder whether he has just come out of the closet as a proper Conservative himself.

[Frank Dobson]

People have described me as old Labour, but I have moved on from that. I am now heritage Labour. Part of our heritage, however, is the national health service, and it is not the Tories’ heritage either. Those who play with the national health service—which is what I think the Government are doing, purely for ideological reasons—do us a disservice in two ways. They threaten the likely performance of the national health service and the people working in it, and they threaten the relationship between the British people and the national health service.

NHS Future Forum

Dan Byles Excerpts

Tuesday 14th June 2011 Commons Chamber

[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.

[Dan Byles (North Warwickshire) (Con)]

Does my right hon. Friend agree that the discourtesy and mock anger from Opposition Members demonstrate why it is so important to take politics out of the day-to-day running of the NHS, so that we avoid this sort of political football nonsense every time we try to implement sensible reforms of this vital public service?

[Mr Lansley]

My hon. Friend is absolutely right, and that may be why Opposition Front-Bench Members have not told us whether they agree with the Future Forum. The truth is that they know they have to agree with it, because it makes good sense, but they are also trying not to let their political opportunity drift away from them. People will be deeply disappointed, and in some cases angry, that they cannot abandon trying to turn the NHS into a political football.

NHS Reform

Dan Byles Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman is wrong on almost every count. We have seen a decade of declining productivity in the NHS. The Office for National Statistics and the National Audit Office set that out recently. We have seen an NHS that, despite record increases in funding, which are welcome, is still not meeting the best European cancer survival rates, as was made clear by the NAO. We need to improve the NHS. The Government are not discounting anybody’s views on how we can best achieve that. In the spirit of continuous improvement in the NHS, there is a spirit of continuously listening about how to make that happen.

[Dan Byles (North Warwickshire) (Con)]

Does the Secretary of State share my amazement that in recent months the Labour party seems to have U-turned on patient choice and on any willing provider, and does not appear to support putting clinicians in charge of commissioning health care? Its only policies seem to be “Save the PCTs”, “Save the SHAs” and “Save NHS bureaucracy”.

[Mr Lansley]

I am grateful to my hon. Friend. Perhaps having increased the number of managers in the NHS by 70%, the Labour party thought that it would be swept to victory on the votes of NHS administrators. That did not happen. People in the NHS knew that waste, inefficiency and excess bureaucracy were not the way to deliver the best care for patients. That was Labour’s way; it will not be our way.

Health and Social Care Bill

Dan Byles Excerpts

Monday 31st January 2011 Commons Chamber

[John Healey]

May I urge the hon. Gentleman to look very closely at the Bill and beyond what he hears the Health Secretary say when he talks about it? I urge him instead to look at how local hospitals could be undercut by private health companies, and at how GPs could be forced to put out work to those companies. That will undermine local hospitals such as the one in Burnley and lead to hospital closures driven not by proper planning and the development of better services in the community, but by hospitals being driven to the point of bankruptcy and closure.

[Dan Byles (North Warwickshire) (Con)]

The right hon. Gentleman does not seem to understand how the health service operated under his Labour Government. My constituents in Warwickshire have been suffering because NHS Warwickshire, under the rules we inherited from his Government, set up a fixed-price, below-tariff contract with one of the trusts in its area that has led to patients being drained from the George Eliot hospital trust in my area and the area of my hon. Friend the Member for Nuneaton (Mr Jones) to Warwick. It was Labour’s rules that allowed it to undercut the hospital in my constituency.

[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.

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[Mr Kevin Barron (Rother Valley) (Lab)]

I shall move on quickly. We had seven hours and 45 minutes to debate the Bill, but the first hour and 15 minutes was taken up by Front Benchers. Given that the Government have not found time to debate the White Paper that they published in July, we should probably have had two days’ debate on a Bill as important as this. As the shadow Secretary of State said, it is far larger than the 1948 Bill that established the national health service.

I find it difficult to find any justification for such a major reorganisation of our NHS. We have had a decade of major investment and we have seen improving services and major satisfaction ratings given by patients. In November 2009, the then Leader of the Opposition, now Prime Minister, said that

“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”

He was supported by the now Secretary of State for Health, who said as shadow Secretary of State in July 2007 that the NHS needed no more top-down reorganisation. Indeed, even after the general election, the coalition agreement stated:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”

It went on to spell out the continuing role of PCTs in some detail, pledging:

“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust…The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level”.

A few months later, we have this potential chaos thrown on to the national health service. Once again, people are looking at the NHS and trying to change its culture by reorganising it.

We have had 30 years of Governments of different political persuasions trying to change the culture of the national health service by reorganisation. Every time, there have been years-long delays in implementation, performance has been affected in a negative way and there have been costs—particularly on this occasion, when the NHS is being instructed to make efficiency savings.

I agree with the report on commissioning just published by the Health Committee. I am not too sure whether the Chair agrees with it himself; the right hon. Member for Charnwood (Mr Dorrell) spoke earlier. The report states:

“The Coalition Programme anticipated an evolution of existing institutions; the White Paper announced significant institutional upheaval. The Committee does not believe that this change of policy has yet been sufficiently explained given the costs and uncertainties generated by the process.”

The last 30 years should tell the House and the Government exactly that.

[Dan Byles]

Will the right hon. Gentleman not concede that the Bill does not represent any reorganisation of NHS bureaucracy, of which there were many under the previous Government? It represents the abolition of a whole tier of unnecessary bureaucracy.

[Mr Barron]

That is an interesting comment, but the Bill does not represent that. In my borough, the PCT—as was; it still is, although it is now Rotherham NHS—will become the GP commissioning consortium. Let us not get away from that. The idea that getting rid of the strategic health authorities or anything else is going to save massive amounts of money is palpable nonsense.

Does anybody think that top-down meddling is going to end because of this reorganisation? If the local GP consortium does not offer provision as it should, the national commissioning board will tell it what to do. If that is not top-down, I do not know what is. Those will be the people responsible for whether local residents, particularly those who need specialised commissioning, are going to get the services or not. The idea that those people are going to be responsible for NHS dentistry in my constituency is nonsense. There has now been a move away from midwifery, and that was going to be commissioned nationally. The changes are nonsense; they have been ill thought out.

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[Dan Byles (North Warwickshire) (Con)]

I am grateful for the opportunity to speak in this debate, and declare an interest in that my wife is a general practitioner.

It is an oft-stated fact that the NHS holds a special place in the hearts of British people. That is why it is so important that this vital institution is managed effectively and sustainably so that our children and grandchildren can continue to use and rely on it in the years to come. However, the problem with the cherished position that the NHS holds is that it makes it difficult to discuss and debate its future dispassionately. It is extremely important that we in this House are able to discuss NHS reform sensibly and without the hyperbole and hysteria shown by the shadow Secretary of State in his opening remarks and by the hon. Member for Eltham (Clive Efford), whose frankly disgusting remarks were not worthy of this Chamber.

The previous Government, who undertook considerable, frequent and, dare I say it, well-intentioned reorganisations of the NHS, found that each reorganisation was opposed by a variety of interests for a variety of reasons. Although they spent too much time reorganising the bureaucracy of the NHS, and generally adding to it on each occasion, I welcomed some of their reforms and am happy to say so, with the notable examples of foundation trusts and the greater involvement of private and other providers. In too many cases, however, previous reforms took the form of shuffling the management deck chairs. Strategic health authorities and primary care trusts were reorganised and reorganised again, often before the ink at the top of the old letterheads had dried, while the number of bureaucrats soared relentlessly.

The challenges faced by the NHS are considerable, and to deny the need for further change is dangerous. Cost pressures within the NHS are rising. This has, in part, been driven by the blunt way in which the previous Government pushed up health spending without insisting on robustly improving outcomes alongside that increased spending. As a result, we have seen productivity fall—a trend that must be reversed if the NHS spending model is to be sustainable. That health care inflation has also been driven by outside factors. Costly new drugs and treatments, coupled with an ageing population, have created serious challenges and will continue to do so.

A hard-headed analysis of these demographic changes has led the coalition Government, rightly, to commit to ring-fencing the NHS from Government spending cuts and guaranteeing real-terms increases in NHS spending—a commitment, I might add, not matched by Labour. With the privilege of a ring-fenced budget comes a responsibility on the side of the NHS to maximise productivity and efficiency to ensure the best possible clinical outcomes for patients within that budget settlement.

[Mr Anderson]

If it is a ring-fenced budget, why does the Royal College of Nursing believe that there will be 27,000 fewer nurses in a year’s time?

[Dan Byles]

The NHS budget is going up in real terms every year, as the hon. Gentleman can see by looking at the books. We are all aware that the system we inherited had ongoing problems because of the high management costs and other structural problems within the NHS. There will be no shortage of nurses as a result of any underfunding by the current Government—I can assure him of that.

[Stephen McPartland (Stevenage) (Con)]

Does my hon. Friend accept the figures from the Royal College of Midwives showing that in 1997 there were more midwives than managers in the NHS, and in 2009 there were 18,000 more managers than midwives?

[Dan Byles]

I am grateful to my hon. Friend for making the point exactly. The NHS cannot carry on with management levels and layers of bureaucracy of the kind that the previous Government put in place. With an ageing population, it is even more important that the largest possible slice of the NHS budget is spent on patient care, and as little as possible on management and administration. Reform of the commissioning process is central to that.

The Bill has been criticised by Opposition Members for doing something that Government Members have been critical of in the past: reorganising the management structures yet again. However, anyone who looks at the Bill honestly and dispassionately will see that it does not reorganise NHS management structures, but sweeps away a whole tier of NHS management structure. It is not another round of shuffling the management deck chairs, but a bonfire of some of those management deck chairs. I strongly welcome the fact that the Bill abolishes primary care trusts and puts general practitioners in charge of commissioning services on behalf of their patients. I criticise nobody who works within PCTs, but I freely criticise the structure that puts health care commissioning in a bureaucratic body that operates at arm’s length from patients and doctors.

I am conscious that many hon. Members still wish to speak, so I will draw my remarks to a close with one plea to the Minister. I understand that under the new GP commissioning process, GP consortia will, in effect, be given control of two budgets: the budget for clinical services and a small budget to cover the management costs of taking over the commissioning process. I also understand that they will not be permitted to transfer unspent funds from the management budget to the clinical budget. If my understanding is correct, I urge the Minister to reconsider that restriction. In giving the consortia a budget for management that cannot be transferred to the clinical budget, there is no incentive for them to drive down their back-office costs. For the process to work most efficiently, GP consortia must have an incentive to drive down their back-office costs in the knowledge that it will allow them to spend more on their patients. To do otherwise gives the incentive to use up the management budget regardless of need—to hire that extra secretary, not because there is a need, but because the budget is there to do so. Such unfortunate incentives from central Governments over the years have led to many productivity problems throughout the public sector and to a use-it-or-lose-it culture. I urge the Minister to look again at that restriction, which seems to go against the new culture of efficiency and responsibility for budgets that we are trying to instil across the public sector.