Covid-19: Government Response

Emily Thornberry Excerpts

Thursday 21st October 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

I gather there may be a point of order. Did somebody wish to raise a point of order? We need to move on. There should be a statement from the Secretary of State.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

On a point of order, Madam Deputy Speaker.

[Madam Deputy Speaker]

Ah—a point of order!

[Emily Thornberry]

Can you advise me how best to deal with the stress levels created by this morning’s timetable? I do not mean to complain—I am a big girl—but, quite frankly, I had departmental questions this morning, we heard on the grapevine that there was going to be a statement on the Trade and Agriculture Commission, for which we have been waiting for more than six months, and we also heard last night that there was going to be a deal with New Zealand.

I got a copy of the Government statement on the deal with New Zealand at six minutes past 10 this morning, when I was obviously on my feet dealing with departmental questions here. I do not complain about where my office is, as I have a wonderful office, but it does take quite a long time to get to it. I need to get to it, pick up the statement that has been given to me by the Government, read it, write what I am going to say, make sure that it is only half the length of the statement and then come back.

I also want to make reference, of course, to the Trade and Agriculture Commission, which the Government have said is a really important part of any future deal that they negotiate, because of the grave concerns that farmers have about their future business, to which the TAC is supposed to be part of the remedy. We got a written ministerial statement, which I received 20 minutes ago while running back from my office. [Laughter.] I got a ministerial statement at six minutes past 10. We have to put all those things together. Although in many ways it is funny, if I was a frontline farmer I would not find this funny at all.

[Madam Deputy Speaker]

I thank the right hon. Lady for that point of order. I very much suspect that the Secretary of State should also thank the right hon. Lady for that point of order. We have had some examples this morning of the way in which not to do business in this House. It is vital that Secretaries of State ensure that they are here in good time for their statements. I think that expresses the opinion of all in this House. Stress levels have been raised by this, so the best thing now is to move on as quickly as possible. I am sure that the International Trade Secretary will want to apologise—I call her to make her statement.

Junior Doctors’ Contracts

Emily Thornberry Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

I do agree. I was talking about a seven-day NHS. A truly 24/7 NHS does not just mean consultants being more readily available; it means 24/7 access to diagnostic tests, social care, occupational therapists—the list goes on. If the Secretary of State has a magic pot of money to pay for all that, bearing it in mind that the NHS can barely pay for the work that it is currently doing, I am all ears. If his plan is to deliver seven-day services by spreading existing services more thinly, he should come clean and say so.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

My hon. Friend makes a very powerful speech. I bring her back to an earlier point which needs emphasising. At the moment trusts have to provide rosters that are not only fair but safe, so that junior doctors get time off. Now it seems that trusts will no longer have to pay attention to those rules and will no longer be fined if they do not follow them.

[Heidi Alexander]

There are very serious concerns about the proposed new contract, and my hon. Friend is right to highlight them.

The sad thing is that it did not have to be this way. Instead of using the dispute with junior doctors to suit his own political ends, the Health Secretary should have listened. He should have understood the depth and strength of concern before it got to the point where junior doctors feel as though they are the first line of defence in a fight for the future of the NHS. Instead of telling junior doctors that the BMA was misleading them, he should have respected their intelligence and responded to their concerns. At the very least, he should have heeded the words of the present Prime Minister, who said this about junior doctors when addressing a rally in 2007:

“There’s a simple truth at the heart of this: you came into the NHS not because you wanted to get rich or famous, but because you have a vocation about curing the ill, about serving your community.”

The Prime Minister went on to say in his conference speech a few days later:

“I will never forget walking on the streets of London marching with 10,000 junior doctors who felt like they were being treated like cogs in a machine rather than professionals with a vocation to go out and save lives”.

It is time the Health Secretary started treating junior doctors like the intelligent professionals they are. When I spoke at the junior doctors rally in London 10 days ago, I delivered a message for the Health Secretary. He was not working that Saturday so I repeat it for him now: stop the high-handed demands, show you are prepared to compromise and put patients before politics.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right. The fact is that this is a package designed to ensure that we eliminate the weekend effect, and it involves both junior doctors and consultants, because they both have their part to play.

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress before taking any further interventions.

The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.

Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.

For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.

--- Later in debate ---

[Mr Hunt]

There is no reason whatsoever. What was strikingly absent from the shadow Health Secretary’s comments was an entreaty to the BMA asking it to come and negotiate. Labour Members can play a constructive role in this, but so far they have declined to do so.

[Emily Thornberry]

Is the right hon. Gentleman going to continue with his plan to change the rules so that trusts that insist on doctors working unsafe hours can no longer be fined for doing so? It will help if he can assure us that those rules will continue and trusts will be fined if they break them.

[Mr Hunt]

They are not fines; they are perverse incentives to doctors to work unsafe hours. We want to go one better than that. We propose to stop hospitals requiring doctors to work five nights in a row or six long days in a row, and to bring down the maximum number of hours that hospitals can ask a doctor to work in any one week. On top of that, we have imposed the toughest hospital regime of any country anywhere in the world that comes down very hard on hospitals that are not providing safe care.

NHS Reform

Emily Thornberry Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his support for that Bill. I hope that plans that NHS England will announce shortly about how we can improve early cancer detection will give him much encouragement. He will see that some of the things that he is campaigning for are actually going to happen.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Everyone supports seven-day-a-week, 24-hour NHS care—who would not? But the bottom line is that there are insufficient resources and insufficient people at the moment for it to be possible to deliver those services. For the Secretary of State to try to blame the health unions for that is not fair, and there are people behind that. The tone of the statement that the Secretary of State made this morning at the King’s Fund has already caused alarm among GPs, and Maureen Baker, chair of the Royal College of General Practitioners, said that this announcement

“will sound…alarm bells for hardworking GPs who fear we will be next in line—even though we are already being pushed to our limits in trying to provide a safe five-day”

a week

“service for our patients.”

[Mr Hunt]

I do not blame doctors; I do not blame the unions. I blame Ministers from the hon. Lady’s Government who gave consultants an opt-out at weekends that has had a catastrophic impact on patient care. I am delighted that she supports seven-day care, but it was not in the Labour manifesto; it was in the Conservative manifesto, and we are putting in extra money—£5.5 billion more than Labour was promising—to ensure that we can pay for it.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

The right hon. Gentleman talks about access to GPs. Will he wait a moment and think about Islington South, where this month we have three GP surgeries closing because our GPs have all resigned? Given the changes in the funding formula that this Government have overseen, will he meet a group of inner-London MPs to talk about our grave concerns about the change to funding and the lack of resources available to GPs?

[Mr Hunt]

I am happy to ensure that inner-London MPs have a meeting with the Minister to discuss those issues. The underfunding of general practice has been an historical problem, because we have had very strong hospital targets, which have tended to suck resources into the acute sector and away from out-of-hospital care. We want to put that right.

--- Later in debate ---

[Mr Hunt]

I am very aware of the problems at Broomfield hospital. The Care Quality Commission has used its enforcement powers to impose an urgent condition on the trust. We will be following it closely, but we need to see urgent change there.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

T8. I am very grateful to the right hon. Gentleman for agreeing to meet me and some inner- London MPs to discuss the crisis of GPs in Islington and the surrounding area. In preparation for that meeting, will he look very carefully at the funding formula? It has changed, which means that resources have moved out of inner London to areas such as Bournemouth, where there are more older people. We need to look very carefully at that. Three surgeries have closed in Islington.

[Mr Hunt]

Of course we will look at the funding formula, but it needs to be fair to the whole country. The hon. Lady’s area is not the only one facing pressures in the GP system. Our ambition is to solve the problem everywhere.

NHS (Government Spending)

Emily Thornberry Excerpts

Wednesday 28th January 2015 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.

Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.

The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?

[Dr Poulter]

rose—

[Emily Thornberry]

I give way to the doctor.

[Dr Poulter]

The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.

[Emily Thornberry]

I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.

I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of my life. I remember my hon. Friend the Member for Leicester West (Liz Kendall) and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.

We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.

People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.

More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.

I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?

Mid Staffordshire NHS Foundation Trust

Emily Thornberry Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

This is the heart of the change that we are making this year. My hon. Friend and I know exactly how well all the schools in our constituencies are doing, because there are transparent, independent Ofsted ratings, but we do not know how well our local hospitals are doing. We need an expert to go in and look at hospitals and then tell us, in language that non-clinicians can understand, just how well they are doing, as well as what needs to change when they are not doing well. We will get that with the new chief inspector of hospitals.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I was struck by the Secretary of State saying that cruelty became normal in the NHS. I do not agree with him and I do not think that the public believe that cruelty has become the norm in the NHS. Most people join the NHS as a calling or a public duty: they believe in kindness and the importance of care.

It seems to me that one of the reasons for cruelty—and it does happen—is the stress of under-staffing. I understand that, as a result of the report, the Secretary of State will publish safe staffing levels ward by ward, but that he will not enforce them. The question that the public want answered is why. How can he, as Secretary of State, be happy to know that wards up and down the country are under-staffed and unsafe, and that he is not doing anything about it?

[Mr Hunt]

We have had a very bipartisan discussion this afternoon, so I am slightly disappointed that the hon. Lady is twisting my words. I did not say that cruelty became the norm everywhere in the NHS; I said that in places such as Mid Staffs cruelty became normal. If she reads the Francis report, she will find that that is the case.

Trying to duck or run away from that fact is what got us into a great deal of trouble, because we did not deal with the issues in Mid Staffs nearly as quickly as we should have done. On staffing levels, we are doing something that did not happen before. When her Government were in power, we did not know where staffing was unsafe, but now we will know and can do something about it.

Hospital Mortality Rates

Emily Thornberry Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I would be delighted to do that. I try to visit somewhere on the front line in the NHS every week, making sure I do not just visit the best places; I visit places that have problems and places like Colchester hospital which are improving—I am delighted that Sir Bruce’s report recognised that.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

The Secretary of State began his statement with an alarming story about patients being left unmonitored on trolleys—I understand that took place at Tameside hospital. Does he agree that there may be a connection between that and the fact that there are 128 fewer nurses, midwives and health visitors in that hospital than there were in 2010? Given that the previous Government flagged up that hospital as one of particular concern, was he watching it to make sure that there were no cuts in nursing staff there?

[Mr Hunt]

As I have said many times, where there is not safe staffing we need to put that right. As I have also said, there are 8,000 more front-line staff under this Government than there were when the hon. Lady’s Government were in power. But those are not the only issues; we also need to address issues of leadership, of systems, which we talked about, and of clinical effectiveness. We need to sort out all those. On staffing numbers, I would just point out that plenty of hospitals under equivalent financial pressures are managing to deliver outstanding care, so a lot of this is about getting the right leadership in place at a board level.

NHS Risk Register

Emily Thornberry Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is safely in Dover, a long way from Wales, when he says these things, but I go to Wales and he is absolutely right. It is staggering. The right hon. Member for Leigh and his colleagues can stand there and say, “Oh, well, you know, it’s only”—what is it?—“8% of patients who are not being seen within 18 weeks.” In Wales it is 32% of patients who are not being seen—

[Emily Thornberry (Islington South and Finsbury) (Lab)]

In Wales!

[Mr Lansley]

If the hon. Lady wants more, I will give her more. In this country—in England—we are increasing the NHS budget, despite the fact that her right hon. Friend the Member for Leigh said it would be irresponsible of us to do so. We are increasing the NHS budget in this Parliament in real terms each year. In Wales—

[Emily Thornberry]

Hooray!

[Mr Lansley]

Perhaps the hon. Lady ought to talk to her friends from Wales, because she is deriding Wales. The Wales Audit Office said that the Labour Government there were going to cut the NHS budget in Wales by over 6% in the course of this Parliament. The Wales Audit Office said that on present trends, by 2014-15—before the next election—expenditure on the NHS would be lower in Wales, under Labour, than in any other part of the United Kingdom. Come the next election, it will be Labour that has to defend its neglect of the NHS in Wales, while we in the coalition Government will be able, together, to defend and promote our stewardship of the NHS, including resources for the NHS.

Health and Social Care (Re-committed) Bill

Emily Thornberry Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

Four weeks ago I was not sure whether I would get to the point where I could speak in the Chamber today. This has been a long and hot-under-the-collar summer. Following my announcement of my intention to table the amendment, I have been threatened with being throttled, car-bombed, burned alive and a host of other distasteful and unpleasant ways in which I would meet my end.

I shall not go into detail about any of these responses to my amendment. Needless to say, some of them involved bodily functions to a graphic degree, and some of the scatological messages were unbelievable. I will not repeat the bile that has poured into my inbox every day. I do not think there is anything that I or my staff could be threatened with, or that we could read or be told now, that would elicit any shock from us. There is nothing worse that we could hear.

Before I go into the detail of the amendment, I shall talk about a significant and substantial shift as a result of the amendment. It has always been the tradition of the House that abortion issues have been discussed and debated in the Chamber and the media have commented on what happened, usually in a reasonable way. But the amendment has changed the game for ever. All Members in all parts of the House know, particularly from the 2008 debate, that we debate with passion. I would say that the 2008 debate was one of the best debates of the previous Parliament. However, we all remain courteous and friendly with each other following the debates. The usual parliamentary knock-about and the usual games take place—I shall say more about that in relation to the amendment in a moment—but the debate usually takes place here and the media comment on what happens here as it happens.

I have no greater opponent in the House on this issue than the right hon. and learned Member for Camberwell and Peckham (Ms Harman). In 2008 she was the whipper-in and the mover behind what happened in that debate, but I have no greater respect for almost any other woman in the House than I do for her. I hugely respect what she has achieved for women and humanity, and I know that she approaches the issue honourably, as I hope I do. It is incredibly sad, therefore, that my summer has been made so difficult not by Opposition Members, who have all been incredibly quiet, but by the nastiness and the response of the left-wing media and union-funded organisations.

The past four weeks have been incredibly difficult. The campaign against the amendment has been co-ordinated by an organisation known as Abortion Rights, which is funded by Unison and a number of other small unions. It also received membership contributions, but, as I was told in a meeting with the organisation, it is largely funded by the unions and Unison is the biggest contributor. [Interruption.] I am not saying that every penny is not accountable; I am just informing the House that the campaign has been funded by the unions. I do not think that there is a problem with that.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Who funds yours?

[Nadine Dorries]

I will tell the hon. Lady exactly who funds my campaign—nobody. Neither I nor my office has received a single penny. Here, to me, is the disadvantage of the amendment. The unions can contact Members’ constituents and ask them to e-mail individual MPs, but I cannot afford to promote the amendment in that way. The press barons, whom the unions have fed with their response to the amendment, can pour what they want into the newspapers, but I cannot. What we have seen is an absolute divide.

Health and Social Care (Re-committed) Bill

Emily Thornberry Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

My hon. Friend is right in relation to the independent treatment centre contracts. They were constructed in a way that effectively removed most of the financial risk from the operators. For other private sector operators in the NHS that is not necessarily true. For example, most of us would recognise that private sector providers are instrumental to continued access to many NHS diagnostic services. There are providers who could fail and at the moment no regulatory structure is in place for that.

Let us continue down the path of the implications of the removal of part 3, which the Labour party proposes. Part 3 includes clause 60. I am sure that Opposition Members are familiar with clause 60, their having served in Committee for so long. It is the means by which, if the hon. Member for Islington South and Finsbury (Emily Thornberry) recalls, we can consider the application of Monitor’s functions to adult social care. So precisely when we are legislating to be able to consider whether the implications of an issue such as that at Southern Cross are such that there should be an additional prudential regulatory regime, the Labour party would take away that opportunity.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Does the Secretary of State agree that it is unfortunate that the Government have not had an opportunity to table detailed amendments on how they would deal with situations such as Southern Cross? To table an amendment that simply says, “At some stage in the future, the Government may be able to do something about a failing organisation such as Southern Cross”, is not necessarily adequate. Although there will be a White Paper on social care next spring, we understand that there are unlikely to be any further details until that point.

[Mr Lansley]

I am confused. I understood that the hon. Lady was a member of the Bill Committees. [Hon. Members: “She was.”] She does not seem to have learned what is going on in the Bill. Clause 60 was not an amendment; it was in the Bill from the outset. It was not introduced as a result of what happened at Southern Cross. We had anticipated the need to address the extent to which Monitor’s functions in relation to the health sector—

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Lansley]

No. I will answer her question. The functions that it exercises in relation to health care include assessing viability and taking action if access to services or the interests of patients or care users are threatened. The Government can consider that by virtue of clause 60. It was not an amendment. So the idea that the measure could not be scrutinised is absurd. It has been in the Bill through all the 100 hours in Committee. If the hon. Lady never said anything about it, that is her own fault and as the shadow care services Minister she should have been more on the ball.

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Lansley]

No. She can sit down.

Let me come to the other Opposition amendments. Amendment 10 would delete all of part 3, which would be absurd. Some of the other Opposition amendments are equally absurd. Amendment 28 envisages that part 3 would remain in place, but that Monitor would license providers of NHS services. However, it then takes away any means of enforcement. Perhaps the Labour party has forgotten that in government if you create obligations it is rather helpful to create a means by which they can be enforced.

Opposition amendment 44 would take the Bill down a slippery slope by trying to prescribe the range of factors that Monitor should reflect in setting prices for NHS services. Such a list could never be exhaustive and would inevitably suggest that some factors were more important than others. It would undermine our ability to hold Monitor to account for setting prices that promote patients’ interests. We must focus Monitor on its duties to promote the quality, efficiency and effectiveness of NHS services, not on trying to prescribe in legislation how it goes about it.

Labour Members have tabled amendments to part 4 that indicate that they either do not understand the Bill, or have abandoned their previous, repeated commitment to supporting all NHS trusts in becoming foundation trusts. They gave that commitment back in 2003, when they passed the necessary legislation, and repeated it in about 2006, when they said that trusts should all be foundation trusts by 2008. The Labour party manifesto from last year—2010—said:

“All hospitals will become Foundation Trusts, with successful FTs given the support and incentives to take over those that are under performing”.

Compare our programme for such hospitals as those in Trafford and Carlisle. The manifesto continued:

“Failing hospitals will have their management replaced. Foundation Trusts will be given the freedom”—

additional freedoms—

“to expand their provision into primary and community care, and to increase their private services”.

We will debate that later today, but I should complete the quote, or I might be accused of being selective:

“where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

That is exactly what we are proposing.

The Labour party appears utterly confused. Does it support foundation trusts or not? The NHS Future Forum said that all NHS trusts should continue to work towards achieving FT status by 2014. It was right: achieving FT status is about demonstrating clinical and financial stability, and we think that all NHS providers should be expected to do that, in the interests of NHS patients and staff. If we maintained the NHS trust legislative model in statute, we would risk losing the change in mindset and the momentum that is being demonstrated by prospective foundation trusts.

Our consequential amendments 219, 220 and 367 to 370 will simply remove references to NHS trusts when they no longer exist—and not, of course, until then. For the hon. Member for Pontypridd, I add that our amendments 185 to 188 make it clear that—sadly for those in Wales—a foundation trust cannot merge with or acquire a Welsh NHS trust.

The Opposition want to take the retrograde step of de-authorising foundation trusts, retaining NHS trusts under the Secretary of State’s direct control, and having them dependent on the layers of bureaucracy that go with that. There would be all the regulatory requirements for foundation trusts and independent providers, and all the bureaucracy that has accompanied NHS trusts and strategic health authorities. That would undermine the FT regulatory regime and the objective of all NHS trusts becoming FTs. Opposition Members who voted in favour of the original legislation establishing foundation trusts in 2003 can have no credibility in supporting Labour now, because the very purpose of that legislation was to give hospitals greater autonomy.

Other Opposition amendments would simply result in duplication and reduced coherence in the Bill. For example, amendments 1166 and 19 seek to retain controls on goods and services, and borrowing and property, but that would duplicate Monitor’s powers through the licensing regime. Deleting clause 166, as the Opposition propose would undermine our intention of increasing transparency in the public financing of foundation trusts. I am looking for the hon. Member for Slough (Fiona Mactaggart); this would have been her moment. Through our amendments, we can show how we can maintain support for FTs, if necessary, in a transparent fashion, including through a requirement, which the Labour party apparently wants to delete, on the Secretary of State to publish an annual report showing what form of financial support has been given to foundation trusts.

I turn to the amendments tabled by my Liberal Democrat friends below the Gangway, who expressed their intention of improving NHS services and ensuring sustainable access for patients. We all share those aims, but I believe that we have in place alternative approaches to meeting those aims. The hon. Member for St Ives tabled a series of amendments emphasising the need to secure sustainability in the provision of NHS services. Securing sustainable access to meet patients’ needs is fundamental to good commissioning. We would expect the board to ensure that there was sufficient competency over issues when it authorised clinical commissioning groups to take on their new responsibilities, and when holding them to account for doing that job.

As the Government have said many times, our focus is on outcomes, including ensuring that patients have access to the services that they need when they need them. That the outcomes must be sustainable is obviously implied, but that is not necessarily the same as saying that commissioners must ensure the sustainability of particular providers or particular services, as amendments 1205 and 1209 suggest when referring to the sustainability of “existing NHS services”. In some cases it will not be in the interests of patients to maintain the status quo—for example, where those services may be unable to improve in line with new standards of clinical best practice, or where there is clear evidence that centralising specialist services on fewer sites would improve health outcomes, as we have seen in examples relating to cardiac, stroke and trauma services. So although I agree with the intention behind these amendments regarding the role of commissioners, I must urge the hon. Member for St Ives not to press them.

I addressed earlier the hon. Gentleman’s amendments about integration and collaboration. On integration, we agree with the conclusion of the NHS Future Forum that integrating services around the needs of patients and giving patients greater choice over who provides those services are not mutually exclusive. As the NHS Future Forum made clear, this is a false dichotomy. As the NHS Future Forum’s report stated:

“If commissioners want to commission integrated care they will only succeed in doing this by creating a new market in integrated care services and stopping the current commissioning of episodic services from different NHS organisations.”

As the hon. Member for St Ives will recognise, his amendments 1207 and 1208 are based upon that dichotomy, so I ask him to withdraw them.

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I do not question Ministers’ intentions, which I think are honourable, but I do think that they have the wrong policy. I do not think that they, as some claim, want to push privatisation across the NHS, but I do think that this could end up being a catastrophic policy that unleashes something that, once it goes through, we will be able to regret at our leisure. On that basis, I simply wanted to raise these matters and ensure that we have an opportunity to debate them, primarily for the purposes of probing the issues.

[Emily Thornberry]

I would like to speak to amendment 1165, which stands in my name and those of my right hon. Friend the Member for Wentworth and Dearne (John Healey), my hon. Friends the Members for Leicester West (Liz Kendall), for Halton (Derek Twigg) and for Pontypridd (Owen Smith), and the hon. Members for St Ives (Andrew George), for Southport (John Pugh) and for Leeds North West (Greg Mulholland). It would delete clause 168, which abolishes the cap on the number of private patients who can be treated in foundation trust hospitals. There has been much interest in this issue, and we will seek a vote on the matter if possible.

Earlier, the Secretary of State assured us that the legislation would not result in a market free-for-all. “That will not happen if this Bill is passed,” he said. But close examination of the clause shows that we will certainly be getting a step closer. It will mean that our national health service, where people are tended by our NHS-trained doctors using our NHS equipment, will be full of private patients, who are able to pay more. Hard-pressed hospitals facing increasingly large shortfalls, desperately trying to balance their books, are bound to take in increasing numbers of private patients.

We have been here before. Many of us remember the last time the Conservatives were in power, when there was a two-tier health service: those who could pay got faster treatment and could skip the queue, while those who could not afford to go private had to wait, and many of them had to die.

I am pleased that the Secretary of State has seen the letter in The Times today. It is often concerning to see how he assimilates data, because he seems to listen only to some things and not to others; he listens to what he wants to hear. I hope that he has realised that in The Times today the doctors, nurses, midwives, psychiatrists, physiotherapists and occupational therapists have said that the Bill will destabilise the national health service. They are particularly concerned about the removal of the private patient cap. Why is that? The Government’s own impact assessment, at B156, acknowledges that

“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients.”

We could not have put that better ourselves, and it is in the Government’s own impact assessment of the Bill.

If we lift the cap on the number of private patients in the time of crisis that the national health service is about to go into, as night follows day the number of private patients in hospitals will increase, forcing out national health service patients. As a result, waiting lists will go up, and what will the public make of that?

[Dr Poulter]

As the hon. Lady is well aware, the previous Government introduced the private sector in a number of hospitals, and at the moment the private sector works alongside the NHS, helping to cut down on waiting times and the like. She is concerned about the private sector working alongside the NHS in hospitals. Does she have any concerns at the moment based on what the previous Government did in introducing that side-by-side service?

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[Emily Thornberry]

What is extraordinary is that many people who used to go private felt that it was not necessary to do so under a Labour Government because they did not have to wait as they had to under the Conservative Government—that is one thing that I certainly remember. Yes, we have used the private sector as and when it has been necessary to reduce waiting lists, but we are not talking about that now. We are talking about whether there should be a cap on the number of private patients in national health service beds.

[Dr Poulter]

The hon. Lady is very kind to give way twice. She makes well the point about why the private sector is beneficial. We either agree that the private sector adds value to the NHS and patients or we say that it is a bad thing; it is either working at the moment for the benefit of patients and will work that way in future, or it is not and will not. Which way does the hon. Lady see it?

[Emily Thornberry]

I am sure that that contribution was of some use to someone in this debate, but I am not going to bother to respond to it.

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that the real difference between what was happening under the Labour Government and what is proposed in this Bill is that we used the private sector to treat people on the basis of need identified by the NHS, not ability to pay? This Government propose to allow more people to pay to jump the queue. In that sense, if waiting lists go up, that helps the private sector: there is no point in paying to jump the queue if there is no queue.

[Emily Thornberry]

Exactly; I am very grateful to my hon. Friend.

The Secretary of State, like the Minister of State, the right hon. Member for Chelmsford (Mr Burns), is fond of quoting the Future Forum. I have a quote from Professor Steve Field that I hope will be of assistance to the House when it comes to discussion of the cap. He said in evidence to the Committee:

“if you opened the cap, it made you more likely to be under attack from EU law, competition and Monitor”.––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 14, Q24.]

That is one of the arguments that he used. If the Future Forum is concerned about this being another reason why we should not lift the cap, I hope that the Minister will at least listen to its arguments.

As we heard in Committee, a number of criticisms have been made on both sides of the House about the details of the cap and how it is implemented. Indeed, it is common ground that there ought to be some changes to it. We have no problem about changing and modifying the cap and making it more appropriate, but we do not understand why, just because the cap needs changing, it is simply being lifted completely.

A parallel can be drawn with the carbon emissions cap. If I were working in the Potteries in Staffordshire, I am sure that I would believe that the carbon emissions cap was unfair and went against my personal business. One would need to look at the cap and change it as appropriate in order to make it work properly; one would not get rid of it completely just because there are criticisms of it, unless one had another agenda.

The question is why on earth the Government are considering allowing as many private patients as wish to do so to go into our national health service at a time of crisis, pushing out national health service patients. [Interruption.] If the Minister believes that that is wrong, I will be interested to hear an intervention from him in which I hope he will be able to give us a complete assurance that that will not happen. The fact of the matter is that there are not the necessary safeguards. As we understand it, there will be absolutely no limit. We have no idea how foundation trusts are going to respond to the lifting of the cap. We do not know and neither, with great respect, does the Minister. Why is he allowing this great risk to be taken with our national health service? The clause needs to be looked at very carefully in this place, and I know that it will be looked at very carefully in another place.

[Nicky Morgan]

I am not sure whether the hon. Lady has seen a note from the Foundation Trust Network that was, I believe, circulated to all Members of the House and sets out six positive reasons why the private patient income cap has worked: it has allowed hospitals to build new units, to buy leading-edge technology, to extend mental health support, to offer fertility treatment, and to provide maternity services. There is also the fact that rental income is caught by the cap. There are some positive benefits in allowing private patients access to be treated by hospitals. In particular, at a time of financial crisis, bringing new technology into the NHS must be a good thing.

[Emily Thornberry]

I am grateful to the hon. Lady. I think that if we were to stop and walk away from party politics, we would be quite close on this matter. We do not have a problem with there being a cap; the problem is how it is implemented. I think that, deep down, she agrees with us. The difficulty is that her party wants to get rid of the cap completely, and that will have a completely different effect on the national health service. We are happy to sit down and talk to the agencies that will be affected and to make improvements in the working of the cap, but getting rid of it completely is behaving recklessly with our national health service.

[Nicky Morgan]

The misinformation and emotive language that has been used throughout the whole debate has been using patients at the heart of this. Everything we have heard so far on both sides of the House, perhaps prompted by the hon. Lady’s remarks, has been about how bringing in private patients is bad for the NHS. In fact there are some good aspects. I am pleased to hear that there can be some agreement between both sides of the House.

[Emily Thornberry]

That is why I have been relying on the Government’s impact assessment as perhaps the strongest part of my argument. I have also relied on what Professor Field has had to say. I would now like to turn to Baroness Williams, who wrote an article published on 4 September that I commend to the House, in which she says:

“One thing that remains…is the decision to lift the cap on private beds in foundation hospitals. Not only could that mean that many of our finest hospitals would gradually become private, it also means that inevitably foundation hospitals would be subject to European and British competition law.”

Many organisations and people agree with us on this, and that is why the House should pause and think about what we will be doing to the national health service if we accept this clause. I also pray in aid the Royal College of Nursing’s briefing, which Members who are closely following this debate will have read, in which it says that it is against the removal of the cap and does not believe that it will not have an effect on NHS patients’ access to health care. The BMA has said the same thing.

In essence, the argument is about whether we should have a cap or not. If the House votes tonight to lift the cap, our constituents will ask how it can be that their representative has voted for a clause that allows private patients to fill up the national health service hospital paid for by those constituents’ taxes so that they will be pushed out of it.

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[Mr Burns]

I hope that the right hon. Gentleman will forgive me, but I will not give way, because other hon. Members wish to speak and the debate finishes in 20 minutes.

To my mind, the private patient cap and the proposed new restrictions are both unnecessary and damaging. Indeed, I know that this will drive some Opposition Members potty, but the former Labour Minister responsible for the cap, Lord Warner, repented his sins in the other place, describing it as

“wrong and detrimental to the NHS.”—[Official Report, House of Lords, 12 May 2009; Vol. 710, c. 936.]

I urge Opposition Members not to repeat that mistake and to heed Lord Warner’s advice. I appreciate that the Opposition Benches are not full of champions of Lord Warner—particularly not at that end of the Chamber from which we heard the earlier comments about him—but he is a respected former Labour Health Minister and I would suggest that he knows what he is talking about.

Let me deal briefly with two final points that were made by the hon. Members for Islington South and Finsbury and for St Ives about the safeguards that are in place to offer protection and ensure that NHS patients would not lose out with the removal of the cap. First, the NHS commissioning board and clinical commissioning groups would be responsible for ensuring that NHS patients are offered prompt and high-quality care, and that good use is made of NHS resources, whoever provides care, through robust contracting arrangements. NHS patients will also maintain their right in the NHS constitution to start treatment within 18 weeks of referral. Secondly, as foundation trusts do not have shareholders and cannot distribute surpluses externally, and as their principal legal purpose will remain to serve the NHS, all proceeds from non-NHS work would be reinvested in the organisation, ultimately adding to the level and quality of the NHS service.

The Bill will make FTs more accountable and transparent to their public and NHS staff. Our commitment that FTs will produce separate accounts for their NHS and NHS private-funded services—as well as Monitor’s use of its regulatory powers to ensure a level playing field between providers—will also help to avoid any risk of NHS resources cross-subsidising private care, thereby protecting NHS money. I believe that those five safeguards will protect NHS patients and the NHS, and will not lead to the situation that the hon. Member for Islington South and Finsbury described in her speech.

[Emily Thornberry]

I do not mean in any way to suggest that the right hon. Gentleman does not believe what he has just said, but what if he is wrong? It is all very well for him to say, “We’re going to lift the private patient cap—we have these safeguards and I believe they’re sufficient to ensure that NHS patients won’t suffer,” and he may be right. However, the difficulty is that he may be wrong, so why are we taking this risk at a time like this? What is the point? What is the benefit?

[Mr Burns]

I do not think that this will come as a surprise to the hon. Lady, but I do not think that I am wrong, and I say that for the following reasons. First, there has never been a cap on NHS trusts, and the problems that she has speculated about during this debate have never occurred where there is not a cap. Secondly, the reasons that I have outlined would suggest to me that there will not be a problem, particularly as the one hospital that I singled out—the Royal Marsden—has an income cap of 30.7%. Nobody is suggesting that NHS patients are suffering as a result of that, and that is where a substantial income comes from non-NHS work. Finally, the five safeguards that I have highlighted will be powerful measures to ensure that what she describes will not happen.

For those reasons, I would be grateful if my hon. Friend the Member for St Ives did not press his new clause to a vote. I would also hope that, on reflection and having made her points, the hon. Member for Islington South and Finsbury will resist the temptation to press her amendment to a Division. I fear, however, that she is not going to heed my advice, and she will regret it.

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[John Pugh]

I supported the amendment tabled by the hon. Member for Islington South and Finsbury (Emily Thornberry)—or, rather, I tabled it independently. I accepted at the time that it was not the most elegant way of dealing with the problem, but I recognise that there is a problem, as do foundation trusts. The cap as it stands has certain perverse consequences, and the NHS cannot fully profit from sources such as intellectual property. NHS profits help to subsidise public services. As the Minister has pointed out, there is no cap on non-foundation trusts, and the current format was to some extent a political compromise because Labour Members raised certain considerations during the passage of the legislation on foundation hospitals. That does not mean that their concerns were not valid at the time.

I am not concerned by the prospect of dramatic privatisation overnight; nor do I think that queue-jumping is the real danger. By abolishing the cap altogether, however, we run the risk that foundation trusts will run on the wrong side of state aid rules, and that their activity will be perceived as economic activity under EU competition law. The more they subsidise general NHS services, the more they will be perceived as engaging in economic activity.

I do not take a doctrinaire view on this issue. Very sensible people, such as Steve Field and the NHS Confederation, have raised the matter. The hon. Member for Leicester West (Liz Kendall) raised it, as did, if I recall correctly, the hon. Member for Islington South and Finsbury in a spirit of compromise in Committee, making the point—I think I am quoting her correctly—that the only alternative to a bad cap is not no cap at all.

There is a genuine fear, however, among people who are far more expert than most hon. Members in this field, which is caused by the blurring of the boundaries between public and private hospitals. We could end up theoretically with a private hospital that has 90% of its patients provided by the NHS. I know we cannot end up with an NHS hospital filled by 90% of private patients, but there is a threshold at which things could quite easily start to become complicated. This a critical issue, which will have to be dealt with in the House of Lords.

[Emily Thornberry]

The hon. Gentleman has quoted me, so let me clarify that I was quoting the Deputy Prime Minister when I said that the only alternative to a bad Bill was not no Bill at all. I was talking about a Bill as opposed to a cap.

[John Pugh]

I may not have paraphrased the hon. Lady correctly, but I believe that the sentiments I described were expressed by her in discussions of a particular amendment on this subject, but we can go and look at the Committee proceedings to find out whether I am right.

It seems to me that what has happened on this occasion is that the Secretary of State has rehearsed the arguments that we have already heard in Committee. That does not advance things massively. He has supplemented that by saying that better efforts should be made to explain how the cap operates by the foundation trusts themselves, which will be more accountable, as I think he said, to the governing body of the foundation trust. That is an explanation and good explanation is to be desired. The point is, however, that expert opinion—independent of this House— perceives this to be a problem, but it has not been addressed.