Health and Social Care (Re-committed) Bill

Debate between Grahame Morris and Julian Sturdy

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

That is a good point. Like the curate’s egg, the Bill is good in parts—and bad in parts. I am prepared to acknowledge the commitment on health inequalities but, as I have mentioned, there are contradictions in the Bill, and that is what I seek to highlight. My concern is that the new structures proposed in the Bill move us away from a co-ordinated health service and towards a competition-based health service. Failure has been touted by Ministers as a driver of improvement, but following the latest U-turn, that commitment seems to have been dropped. I would welcome Ministers’ views on that.

Our concern is that the health service will be left to the worst elements of privatisation, without the supposed benefits of market competition. Members have referred to the British Medical Association and its calls for a co-operative and co-ordinated environment, which an open market would make impossible. When Dr Clare Gerada, the chair of the Royal College of General Practitioners, gave evidence to the Bill Committee, she raised a number of concerns about the clauses that we are discussing—concerns

“about the duplication of care and fragmentation…the under-provision of care once competition starts kicking in, the pace and extent of change, and the capability capacity and competence of GPs”

to deal with the extent of health needs. Most importantly, she said that

“the Bill risks widening health inequalities and could lead to worse patient care”.––[Official Report, Health and Social Care Public Bill Committee, 8 February 2011; c. 43, Q94.]

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman talks about health inequalities, but does he accept that under the current system primary care trusts have brought about a number of health inequalities? Certainly in my area of north Yorkshire, the PCT has brought about a number of health inequalities, and I think that that is the case in other areas, too. The system is already delivering that; that is why we need the change.

[Grahame M. Morris]

The picture is incredibly variable. We should consider many of the policies that the Government are pursuing, not least that on public health observatories, which collect the evidence on which many public health interventions are based. The sustained cuts to their budgets—there is a cut of 30% this year, and 30% next year—are exacerbating the situation. Some PCTs are performing well in this regard, and some are not performing as well. If there are measures that can strengthen our performance, they ought to be welcomed.

We have in the past mentioned some of the public health issues. As far back as 1977, the Department of Health and Social Security’s chief scientific adviser, Sir Douglas Black, commissioned a report on the extent of health inequalities in the UK. The Black report, published in 1980, brought about a sea change in how Governments would respond to health inequalities and reduce their worst effects, particularly for the lower social classes. It is generally acknowledged in more recent reports by Professor Sir Michael Marmot that the NHS can only do so much to address the situation. There are general issues that must be addressed through a whole plethora of Government policies—child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care, and better housing. I mention that in relation to the amendments that we are discussing to highlight the stark danger of a reversal in relation to health inequalities, which are not only influenced by decisions of the Health Secretary, but greatly influenced by decisions taken across Government.

I shall draw my remarks to a conclusion. I am sure that Government Members will be relieved to hear that. [Interruption.] Well, I could go on for longer if they want; I have another six pages. I draw the House’s attention to the real concerns that the general public, the medical profession, staff who work in the service and patients have about particular details—about the new and expanded role of Monitor, and about the implications for the new NHS. It will not necessarily be Monitor that decides the future of failing services; in the end, that will be decided in the courts. Finally, in parts 3 and 4, we are dealing with some of the most contentious issues in the Bill, and I urge Members to consider the issues very carefully and to think about what is at stake, before deciding how to vote on the amendments.