NHS Reorganisation

Greg Mulholland Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Pugh]

I think it is Hobson’s choice.

This is not the first health reform—the last Government introduced more “step changes” than could fill an episode of “Strictly Come Dancing”—but it is certainly the biggest, the most expensive and possibly the most risky. The Secretary of State seems to have chosen for himself a path on which future generations will either put up statues to him or burn him in effigy. However, it is no longer his Bill; it is our Bill. No Secretary of State currently commands a majority in this House.

This Parliament may act like all the others hitherto—and, sadly, it usually does, as it has largely done today—but it is not like any other Parliament. There is no party in this House with a majority, so we should dump the tribalism, the point scoring and the political games. We can get round to doing what we have to do and what we need to do. We have the chance to scrutinise, to seek to amend and improve—and, if unsatisfied, the chance to reject the Bill on Third Reading. That applies to Members of all parties. It is not just “top-down reorganisation” of the health service that we should have dropped with the coalition; we should have dropped “top-down legislation”, whereby MPs simply become pawns in a wider political game, and conviction takes second place to coercion.

There has never been a Secretary of State who has looked at the NHS and found it to be perfect and incapable of improvement. That is largely because we demand so many incompatible things of it that any incarnation is unlikely to satisfy all. Each successive Secretary of State suggests proposals for reform, rather like the Flying Dutchman in a hopeless and sadly doomed pursuit of the ideal format for the NHS. I have to say that the current Secretary of State is probably better equipped for this eternal task than any others: he is committed, passionate, well informed—probably the best informed Secretary of State we have had for some time—and he is brave. He voyages on, undeterred by the siren voices of think-tanks from right and left and the warnings about costs and practical difficulties, and unfazed by the lack of enthusiasm, if the polls are to be believed, among the NHS crew and staff. Of course, as a Liberal Democrat I am disinclined to believe polls at the moment. He carries on, unmindful of the uncharted nature of the course he has set. In Committee, we found real gaps in the understanding of how things will proceed. It is not that he is unaware of the possible danger, but the big danger is that any potential shipwreck will cause us all to be engulfed if costs overrun, if productivity falls, if hospitals close, if waiting lists grow, if morale declines, or if the NHS appears to be denatured, privatised, and not safe in our hands. That is why Parliament’s role is so important in this context, and why good argument rather than the Government machine must prevail.

[Greg Mulholland (Leeds North West) (LD)]

I pay tribute to the work that my hon. Friend is doing on the Bill. Does he agree that, as with the forestry decision, the coalition shows its strength when it actually listens to the concerns that are out there, and is that not exactly what we need the Government to do at this stage?

[John Pugh]

Indeed. In the circumstances that my hon. Friend cites, both coalition parties listened to the voices that they heard and took serious note of them.

It would be unsafe to draw any conclusions from the voting patterns today. Political gamesmanship and party loyalties will prevail. However, it is not necessary to hang around the Lobbies much to see that a corrosive unease is spreading through Government ranks, even in the most unlikely quarters, and to see how opposition hardens with every defiant, unbending rebuttal from the Richmond house bunker. We must accept that the Committee, for all its forensic talent, will not solve the problem; we must concentrate on Report and Third Reading, and on the debates that will take place offstage beforehand.

This is our Bill, not the Secretary of State’s. It will not come about unless we vote for it. Even the most calculating, the most tribal, the most ambitious of us—but not, possibly, the most stupid—must see the clear risks as well as recognising the opportunities. If we get it right, reform can take place with the grain of professional and expert opinion, without Ministers’ ceasing to be ambitious for the NHS, and with broad political support in the House and in the country, and arguably it will work better as a result. However, it will require dialogue.

It is a profound irony that the Government want to abolish what they call the command and control model of the NHS by means of a command and control model of legislation. Indeed, they issued a Command Paper over the Christmas period, but then Richmond house does not do irony. If Parliament is to help the Government to climb out of the hole into which they threw themselves last June when the White Paper announced the liberation of the NHS, we need genuinely constructive, open dialogue, and we need it to start here. Perhaps, in order to liberate the NHS, we need to liberate Parliament a little bit first.