Health and Social Care Bill

David Miliband Excerpts

Tuesday 13th March 2012 Commons Chamber

[David Miliband (South Shields) (Lab)]

I rise today to make a simple point to Ministers and their supporters: however acute the embarrassment of giving up on the Health and Social Care Bill at this stage, it will pale into insignificance compared with the embarrassment, never mind the trauma and cost, of ploughing ahead with this health reform and making it the template for health policy for the rest of this Parliament.

The Bill has achieved a remarkable feat since we contributed to the Second Reading debate. First, it has taken the Government hostage. It is the political equivalent of the Stockholm syndrome: falling in love with your captor. The Prime Minister insists, in one breath, that he must have the Bill to save the NHS and, at the same time, at Prime Minister’s questions, he insists that 95% of the country has already had the benefit of the reforms that he claims the Bill will put through.

Secondly, in the real world—many miles from the claims of Ministers that they wanted an unprecedented consensus between politicians and professionals—this Bill is without friends. Even more remarkable, and shocking to me, is that it is a Bill that has lost friends at each and every stage of its passage through Parliament. Every compromise, every “concession” and every retrofit has cost the Bill coherence, cost the Bill support and raised levels of anxiety about the Bill.

The reason for that is simple: the Prime Minister, the Secretary of State and the Deputy Prime Minister have made it their calling card to say that the choice is between this Bill and inertia. I know that tactic, as I have written those speeches and those articles, but in this case the problem is that that is not true. The Leader of the Opposition and the shadow Secretary of State for Health have put forward practical proposals to achieve some of these aims that are shared across the House.

The Secretary of State will recognise that more reform is going on in the English health service than in any other health service in the world at the moment—that is the product of what was done under the previous Government. That is perhaps one reason why it is improving faster than those anywhere else. The choice is between good reform and bad reform, and this Bill is bad reform: it gives reform a bad name. In fact, it threatens to set back the cause of reform for a generation, and I want to explain why.

As amendment has been piled on amendment, the Bill has gone from being wrong to being the most half-baked, quarter-thought-out shambles that the NHS has ever seen. I want to give three examples that go to the heart of the issues raised by the Secretary of State and the Prime Minister in their speeches to launch the Bill. The first and most important is managing service change. That is most important, because everyone agrees that the health service has to change to deal with the challenges of demography, drug costs and medical technology, and that means changing in the way in which services are organised. Yet in its hatred of planning and confusion about competition the Bill makes change at a local level not more likely but less. Why? The levers of change have been neutered. Clinical commissioning groups are too small and weak as replacements for primary care trusts, the NHS Commissioning Board is too remote and gargantuan and, as the Palmer study of reorganisation in south-east London shows, market forces on their own will not reconfigure services in a coherent way.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

This weekend I met 80 women from Walthamstow who are desperately concerned because we do not have a sexual health service there, so we have very high levels of teenage pregnancy and repeat abortion, as there are doctors in the constituency who will not provide contraceptives. Does my right hon. Friend agree that the changes could make dealing with such problems harder, not easier?

[David Miliband]

My hon. Friend makes an important point. Far from driving the health service towards a coherent vision of the future, the Bill promises frenetic gridlock as professionals try to make the best of the bad job they have been left by the Health Secretary.

The second example is promoting efficiency. The Select Committee on Health stated:

“The reorganisation process continues to complicate the push for efficiency gains.”

It is, of course, right. The story today that senior GPs are spending four days a week coping with reorganisation rather than treating patients is, I predict, only the first step on that road.

The third example is accountability. If there was a germ of an idea in the original Bill presented by the Secretary of State, it was to align clinical and financial responsibility. In May last year he said that the key question was to

“put the right people in charge”.

After a year, it is completely inexplicable who is in charge: not GPs, because they are overseen by the greatest behemoth of them all, the national NHS Commissioning Board; not hospital trusts, because they are answerable to Monitor and the competition authorities; not the sectoral replacements for strategic health authorities, because they are only temporary; not the managers, because they are being sacked just before they reapply for their old jobs, which now have new names; and not the clinical senates, because their purpose has not yet been defined.

In truth, the new system hardly deserves the title of a system at all. It is not just that people do not support what the Government are doing, but that they simply do not understand what the Government are doing. I warn the House that the real danger for the NHS is a perfect storm of rising costs, rising demand and opaque and inexplicable decision-taking structures.

The Government promised clarity but have delivered complexity. They promised devolution but have had to create the biggest quango of them all. They promised efficiency and they have delivered bureaucracy. The result is that at the end of this Parliament we will once again be back in a debate that I thought we had buried for ever, about whether a tax-funded health service free at the point of need could deliver for the whole population of Britain. That is the last debate we should be having, but it will be the product of the shambles now being created.

I believe the Secretary of State when he says he supports the NHS passionately, but by the end of this Parliament, when the structural flaws of the plan are clear, he will not be around to defend it. That is the true danger of this misconceived and unloved Bill, and that is why this Secretary of State, in his last act of kindness to the NHS, should kill the Bill.