Health and Social Care Bill

Helen Jones Excerpts

Tuesday 20th March 2012 Commons Chamber

[Stephen Pound (Ealing North) (Lab)]

May I trespass upon your good nature, Mr Speaker, to endeavour to speak on behalf of the House to praise my hon. Friend the Member for Easington (Grahame M. Morris), who is not well, but who has risen from his sick bed to join us today because this subject is of such importance?

Those of us who stood at the Bar in the other place listening to the debate—[Interruption.] Not that bar. Those of us who stood at the Bar of the other place listening to the debate on the Bill cannot help but to have been massively impressed by the breadth and depth of expertise that was displayed. We had past presidents of royal colleges and consultants, and people from every aspect of our glorious national health service, giving their expertise, passion and analysis.

I come from a slightly different perspective. I spent more than 10 years working in the national health service—this is specifically in relation to the issue of health and wellbeing boards, in case you are worried, Mr Speaker—before community health councils were established in 1974, when, frankly, the NHS was not run for patients, people or the local community, and when there was little or no consultation with democratically elected local authorities, let alone with special interest groups or people representing areas that were ill served by the NHS. Community health councils had not only statutory powers, but a budget. They enabled the voice of the people to be heard in wards, corridors and A and E departments throughout the national health service.

We have heard tonight an extraordinary, agonising attempt on the part of the junior section of the coalition to justify what had been for years their principled support of a public voice within the NHS. The Liberal Democrats say that they will scrutinise the measure having voted to destroy that for which they have stood for so long. It is like somebody setting fire to a house and saying that they will time how long the fire engine takes to get there—and then criticising it. It ill becomes Members to draw attention to the shortcomings of other Members, but one speaker reminded me of those people in Spain who, on Good Friday, flagellate themselves up and down mountains trying to display their agonies. All the time, the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) tries to show us that he is not enjoying this—he is in agony but that agony will not deter him, I fear, from voting against the amendments.

[Helen Jones (Warrington North) (Lab)]

I hate to disagree with my hon. Friend but is not the difference between the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and the flagellants of Spain that they believe they have sins to expiate, whereas he believes that whatever position he adopts today, even if it is the opposite of yesterday’s, is entirely right and proper?

[Stephen Pound]

I yield to no one in my admiration for my hon. Friend and her knowledge of the slightly occult religious practices of south Spain—and possibly of parts of St Helens for all I know.

But we did not expect the Spanish inquisition. We expected a valid, proper, sensible voice to enable the people to engage with their national health service. The NHS must not be an isolated ivory tower dominated by the old consultant gods who used to run it. It must not be a matter of non-responsible bureaucrats in quangos sending letters of suggestion. The NHS must contain a proper mechanism for the people’s voice to be heard and, above all, for the involvement of the wider community. The NHS cannot be a stand-alone organisation; it has to be involved with local councils and local communities, but everything in the proposals for this mealy-mouthed, milquetoast healthwatch nonsense dilutes and destroys that.

All the proposal does is create a false illusion—a falsity; the suggestion that somehow the voice of the people will be heard through this mere sub-committee of the Care Quality Commission, a committee whose mighty weapons arrayed against the forces of reaction and conservatism consist of the ability to write a letter. Such a letter would have to be vast, powerful and extremely effective, and would have to do what no letter has ever done in the history of epistolatory warfare. It would somehow have to persuade people on this gentle nudge—I appreciate that there are those on the Government Benches much given to the modern, modish philosophy of the nudge, but there is nudging and there is fudging, and what we have heard tonight is a fudge-nudge.

Above all, however, there is a crucially significant and important point here.

Health and Social Care Bill

Helen Jones Excerpts

Tuesday 20th March 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

It is a great honour to take part once again in a debate on the Health and Social Care Bill. I first made a contribution to these debates in 2010 and, as the right hon. Member for Wentworth and Dearne (John Healey) said, since then there have been 14 months of detailed and careful consideration of the Bill’s provisions. That says a lot. There has been criticism both in this debate and previously that the Bill is ill-considered and has been rushed through, but given the consideration of it that there has been over such a long period, and with so much public involvement and comment, that is clearly not the case.

The right hon. Gentleman also said that our NHS is truly a precious institution for each and every one of us—our own family members as well as all our constituents—and I agree. People rely on the health service and hold it very dear, and it is therefore right for passionate feelings to be expressed about its future both in this Chamber and outside. I contend that because we have a changing demographic and magnificent advances in medical technology, the way our national health service is run cannot stay still.

[Helen Jones (Warrington North) (Lab)]

No one on the Opposition Benches has argued that the NHS does not need to continue to improve. That is not what we are discussing; we are discussing the risk register. Does the hon. Gentleman believe that the Government should abide by the tribunal’s decision, or does he believe they should continue to ignore that lawfully made decision?

[Henry Smith]

I think the biggest risk to the national health service is if we do not reform it and move it forward. It needs reform to stay relevant to the needs of all our constituents. I find the Opposition’s position strange—I would put it down to political opportunism, but I am happy to take another intervention if Opposition Members want to state their case—given what happened with the three requests made when the right hon. Member for Leigh (Andy Burnham) was Secretary of State and under his predecessor.

--- Later in debate ---

[Dr Wollaston]

Listening to Labour and seeing the extreme shroud waving that has been going on is, frankly, enough to give anyone a headache. I took the Ibuprofen because of what I read in the impact assessment. The impact assessment presents a sensible, balanced portrayal of the realistic risks and benefits, and warns me of many points of which I need to take heed. It is far more likely that I am going to develop indigestion from taking Ibuprofen than that I am going to collapse from a fatal skin reaction.

[Helen Jones]

rose—

[Dame Joan Ruddock]

rose—

Health and Social Care Bill

Helen Jones Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an extremely good point. Many of the issues that have been the subject of some of the most heated debate on the Bill have been raised because Labour never addressed them. He is absolutely right that one result will be that in future, it will no longer be possible for £250 million to be paid to the private sector for operations that never take place.

[Helen Jones (Warrington North) (Lab)]

Can the Secretary of State explain why he is prepared to get into further discussions with the Liberal Democrats to help them to save seats in May, but not to do so with doctors, nurses and midwives, who all oppose the Bill? Is he engaged in patching up the coalition rather than in providing proper health care?

[Mr Lansley]

I think I made that perfectly clear not only in the course of the initial consultation on the White Paper, but then through the NHS Future Forum. Many thousands of NHS staff contributed their views to the NHS Future Forum, which made many recommendations and we accepted them all.

Vascular Services (Warrington)

Helen Jones Excerpts

Monday 28th November 2011 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

I am very grateful to have the opportunity to discuss vascular services in Warrington, and in particular the decision not to locate a vascular centre there. The review of vascular services conducted by the NHS in Cheshire and Merseyside was fatally flawed. It has no proper evidence base. It failed to engage clinicians in Warrington and Halton and it demonstrated a singular lack of transparency. It failed to adopt the open and transparent procedures used elsewhere and instead held only two meetings—one for staff and one for the public—to cover the two counties. The survey it carried out was on the internet, thus excluding many of the people in the centre of Warrington and in Halton who do not have internet access. The conclusions it drew from that survey were rather bizarre. Although people said that they valued safety first, it does not mean that the position adopted by Cheshire and Merseyside NHS makes things safer. Anyone who follows that flawed logic should not be conducting a review of services in the first place.

We have been left with a decision that will damage service at Warrington and Halton Hospitals NHS Foundation Trust and dismantle the partnership working that has been built up with St Helen’s and Knowsley NHS Trust over the years. It has left unanswered some serious questions about co-dependent services and about possible increased risk and mortality elsewhere. This is a shabby little stitch-up that cannot go unchallenged. If the Minister wants to champion local decision making, it is his duty to ensure that those decisions are properly based on evidence and are reached through due process. That has not been the case here.

This review started by looking at “evac” procedure. It then mutated into a review of vascular services as a whole. It is never a good sign when that sort of slippage occurs. The review then decided that any centre must carry out a minimum of 50 open aortic aneurysm repairs and 100 carotid endarterectomies. Where is the evidence for these figures? The Royal College of Surgeons has never recommended them and many other centres operate using different minima. The suspicion is that the figures were chosen to bolster the case for two centres rather than three, yet Great Manchester will have three, as will Cumbria and Lancaster. Unless the Minister is prepared to argue that centres operating on different minima are unsafe—I do not believe that he is prepared to argue that—there is no evidence base for these figures.

[Derek Twigg (Halton) (Lab)]

I congratulate my hon. Friend on securing this debate and on making an excellent speech. She said that the Minister will probably argue that this is a matter for local decision making but she has shown that there is no clear evidence base, so one would hope that the Minister would ensure that the matter is reconsidered.

[Helen Jones]

My hon. Friend is right. I want to come to some of the other evidence and how the review was carried out. The decision was eventually taken that one centre would be located in Liverpool and one at the Countess of Chester hospital. Originally, the review panel allowed both Liverpool and Chester to take away their submissions and rewrite them from June until October, but it did not allow the same leeway to Warrington and Halton NHS trust. After protests from overview and scrutiny committees, it allowed them only seven days. That is not a fair process.

It is also clear that the review panel originally had reservations about locating a centre at Chester in partnership with Wirral university hospital. It said that

“there were a number of outstanding questions about how the proposed arterial centre would work clinically”.

However, when we asked how those clinical problems have been resolved, answer comes there none.

There were other questions about the skills base, co-dependent services and possible increased mortality rates elsewhere, which it is clear from the impact assessment carried out for Warrington have not been resolved. We were left with the decision to base a centre at Chester—a decision that, I understand, was queried even by its partner at Wirral university hospital NHS trust—that has been designated the south Mersey centre. I have to tell the Minister that I was born and bred in Chester, and it is not on the Mersey but on the Dee, and it is difficult to get to it from elsewhere in the region.

The result of this decision is that centres are concentrated in a relatively small area—one in Liverpool, one in Chester and a satellite one in the centre of the Wirral. There is nothing in the review for those who live in north or east Cheshire, and as a result emergency patients from the Warrington area will now have to travel 30 miles by emergency ambulance instead of the maximum eight miles as before. Those who wish to travel by public transport will, because of the different combinations of buses and trains, be facing a journey of three to four hours. That is important because car ownership in Halton and the centre of Warrington is lower than the national average—people are reliant on public transport.

The questions about access, which were deemed to be important, have not been resolved but there are other troubling issues. It seems that the review—based, after all, on flawed evidence—will form the basis for decisions on other specialties. For example, the review stated that it was highly desirable, if not essential, that hyper-acute stroke units be located with vascular centres. That indicates that Warrington’s chances of getting these services in the future are limited. However, the review also undermines existing stroke services in Warrington—services that are highly rated and delivered in partnership with St Helens and Knowsley trust. If a vascular surgeon is not to be on site, those stroke services will be undermined.

The same is true of trauma care. The review thought it desirable that in the future trauma centres be co-located with arterial centres. That would seem to be pre-judging where those services will be located in future.

As things stand, Warrington often deals with serious cases because it is at the centre of a motorway network. Many will need a vascular surgeon, as well as other specialties. The response from the review was that patients could be stabilised by a general surgeon and that a vascular surgeon would be on site within 30 minutes. Frankly, anyone who knows Warrington’s traffic will know that that is absolute nonsense. The North West Ambulance Service gave evidence to the impact assessment panel about gridlock in Warrington. If the service cannot guarantee that it can get an emergency ambulance through, there is little chance of getting a surgeon through. Indeed, I have done the journey from Chester to Warrington many times, because I still have relatives there. It is not possible to do it in 30 minutes at peak time—one has to get through the traffic in Chester, go along a congested motorway and then get through the traffic in Warrington. Where on earth have those figures come from and how have they been validated?

The suspicion is that the review has been carried out in a cavalier manner in order to fit a predetermined outcome. Indeed, there are also concerns arising from the impact assessment, because the points put by clinicians in Warrington appear to have been accepted, yet nothing has been done about them. For instance, the review panel received evidence that the vascular services in Warrington were well developed and had worked over 10 years in partnership with St Helens and Knowsley trust. The panel accepted that it was desirable to maintain that partnership and that disrupting it was contrary to practice elsewhere in the NHS. The panel said that it hoped that the partnership would be maintained. However, the clinicians in the St Helens and Knowsley trust had already given the panel evidence showing that it could not be maintained if the recommendations of the review were accepted, because transfer times and transport difficulties would mean having to partner with Liverpool.

Similarly, the North West Ambulance Service gave evidence showing that it could not guarantee ambulance response times in Warrington if it had to transfer patients from Warrington to Chester. The service’s figures were accepted by the impact assessment panel, which then said that it was drawing the matter to the attention of commissioners as a cost not yet planned for. Where will the extra money come from to fund extra ambulance services in Warrington, given that the NHS is already expected to take cuts of £20 billion? If the Minister wants to get up and promise us extra money for Warrington ambulance services, we would be very pleased to hear from him, but I do not think he can.

Similarly, the ambulance service drew attention to the fact that Warrington is uniquely prone to gridlock, because if an accident happens on the motorway system, it can gridlock the whole town. The response from the panel was that gridlock was “challenging”. Not being able to get an emergency ambulance through is not challenging; it is life-threatening. Indeed, it is really quite arrogant to dismiss the concerns of those responsible for transferring patients in that way.

However, worse was to come. The clinicians from Warrington and Halton—who, at this stage in the process, were now being consulted for the first time—gave evidence about the impact of removing vascular services on other specialities. In particular, they were concerned about the problems of ensuring support for vascular injury in other surgical procedures and invasive specialities. The panel then said that the volume of patients needing to be transferred could become “unmanageable”. It also said that the number of patients whose services would be disrupted might be greater than the small number who would see an improvement. All that was asked of the review panel was that it should publish its evidence at the same time as its implementation plan. Frankly, that is the wrong way round: if the evidence is not there, there should not be an implementation plan to start with.

[Derek Twigg]

My hon. Friend is most generous in giving way again. I am sure that she will discuss this further, but the areas covered by the two hospitals—Whiston, Warrington and Halton; and Knowsley, St Helens and the centre of Warrington—are some of the most deprived boroughs in the country, and yet the services are being transferred to one of the most affluent parts of the north-west. Does she not think that an odd way to deal with populations that suffer the most ill health?

[Helen Jones]

I agree. One thing that the review appears not to have looked at properly is the incidence of these sorts of vascular illnesses and where the centres should be located to deal with them.

Another interesting issue is that clinicians told the panel that more and more patients would need to be transferred over time as a result of not having vascular services on site. In fact, one clinician on the panel expressed the view that the

“lives at risk in these situations, equalled, or outweighed those saved by the anticipated improvements.”

I have to ask what sort of service improvement it is that can put more lives at risk. Evidence was also given about the difficulty of maintaining cancer services without support from vascular surgeons—Warrington is a centre for renal cancer—about the difficulty of maintaining limbs compromised by diabetes without having those surgeons on site and about the waste of resources, with Warrington having invested in new facilities. It has the most modern vascular lab in the region and the only fully compliant one. That will go to waste if vascular services are transferred, and we will spend millions elsewhere in providing new services on another site.

In short, what we have is a proposal that breaks an existing working partnership—one that has provided highly rated services—that could harm co-dependent services, that could impact on ambulance transfer times in a way that puts other patients in Warrington at risk and that wastes services. In the end, it will seriously damage services at Warrington hospital. In fact, I am told that a consultant interventional radiologist who had already been appointed has now declined to come because of this decision. Yet an implementation plan is going ahead even before we have begun the consultation. That is no consultation at all.

I ask the Minister to look at this seriously. I will support changes in services where they can be shown to improve patient care. I cannot support them where there is no evidence that they will improve patient care and there is a lot of evidence that they will damage patient care in other specialties. The ultimate responsibility, I say to the Minister, is his. I have agreed with Mrs Thatcher on only one thing—when she said:

“Advisers advise, and Ministers decide.”

He has to look very seriously at what has been going on here and he needs to act before other services in Warrington are damaged.

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate, and I totally agree that it is important for patients to have access to high-quality vascular services. I know that she is an active campaigner locally on health issues and a strong supporter of local health services.

The hon. Lady has raised a number of issues about the current review of vascular services in Cheshire and Merseyside. I appreciate that her constituents may be concerned about proposed service changes and want to be assured that they will have access to these services. Due to the shortage of time available, I hope she will forgive me if I do not go into the detail of the background at national level of all that the Government and the NHS are doing on vascular services, health checks, screening and so forth. I would like to address the situation in her constituency that she has raised. If I do not have enough time to provide all the answers to her questions, I assure her that I will write to her.

Currently, the commissioning of complex vascular services varies. In some areas, they are commissioned by regional specialised commissioning groups, but in others they are commissioned by individual primary care trusts. Evidence shows that, in order to maintain the safety and quality of these services, it is better that they are commissioned for larger populations.

There is robust evidence, highlighted by the work of the Vascular Society of Great Britain and Ireland, which shows that patient outcomes are best when complex vascular care is delivered by units that treat higher volumes of patients. In response to that evidence and national screening for abdominal aortic aneurysms, vascular services are being reviewed locally across England.

Reflecting that approach, in June 2010, the NHS in Cheshire and Merseyside embarked on a review of the way in which vascular services are delivered. It deals with non-cardiac vascular services for conditions such as abdominal aortic aneurysms, strokes and mini-strokes. Cardiac services continue, and will continue, to be provided in local hospitals in Cheshire and Merseyside. Vascular services are provided by nine district hospitals across Cheshire and Merseyside, including Warrington hospital in the hon. Lady’s constituency.

The review proposes that local hospitals should work in partnership to deliver the range of vascular services, with arterial complex interventional radiology and emergency surgery being carried out in a small number of arterial centres. Out-patient clinics, initial investigations and follow-up treatment will continue to be provided in local hospitals, including hospitals in Warrington and Halton. Patients with a vascular emergency will be taken to their nearest local hospital—unless the referring GP suggests otherwise—where they will be stabilised. If they require further emergency or arterial surgery, they will be transferred to the arterial centre. I have been informed that vascular surgeons will be based at local hospitals as well as arterial centres, which will ensure that patients can have access to their expertise.

[Helen Jones]

How many vascular surgeons will be based at Warrington, and what kind of rota will there be? The Minister knows as well as I do that problems occur with rotas when those surgeons are not available.

[Mr Burns]

Given that I want to deal with some of the other points raised by the hon. Lady, may I write to her about that? Given the shortage of time, I suspect that I shall also have to write to her about a number of other issues.

The Cheshire and Merseyside vascular review project board led the review, and was advised by a clinical advisory group consisting of local clinicians, including some from Warrington. The group developed a set of standards that each vascular network would need to meet, along with locally agreed minimum activity thresholds. They were considered in the light of the size of the population served by Cheshire and Merseyside. On the basis of advice from the clinicians, the project board concluded that, given the clinical activity and population size, it would be best for two vascular networks to serve populations in north and south Mersey, and that each network should have its own arterial centre.

In January 2011, the project board undertook a pre-consultation of local people, which included public and NHS staff meetings. They presented the pre-consultation to the local overview and scrutiny committees in every local authority across Cheshire and Merseyside, and wrote to local MPs, including the hon. Lady and, I assume, the hon. Member for Halton (Derek Twigg) and my hon. Friend the Member for Warrington South (David Mowat). In October 2011, the board provided the commissioners in Cheshire and Merseyside with a report setting out its findings and recommendations. The report proposed that the arterial centre in the north Mersey network should be based at Royal Liverpool university hospital, while the arterial centre in the south Mersey network should be based at either Warrington hospital or Countess of Chester hospital. However, the final decision was left to commissioners.

The two joint bids for the south Mersey network from the Warrington and Chester trusts were presented to the clinical commissioning group chairs in Runcorn, Widnes, Warrington, Wirral and Western Cheshire. The commissioning groups, including Warrington, unanimously decided to recommend to the PCT cluster board that the arterial centre for the south Mersey network should be based at Countess of Chester hospital. I understand that they felt that the joint bid from Chester and Wirral contained the most credible plan for developing a networked vascular service for the populations of Warrington, Halton, Western Cheshire and Wirral, while facilitating a full range of local hospital services. I appreciate the hon. Lady’s concerns about the impact on Warrington hospital of the arterial centre being located at Chester. I understand the project board commissioned an impact assessment of the changes on Warrington, which highlighted a number of issues, but it concluded that these could be mitigated. The proposals have been considered by the Cheshire, Warrington and Wirral and Merseyside primary care trust cluster boards, which have supported the project board’s recommendations, subject to formal public consultation.

The proposals will also be subject to gateway review and national clinical advisory team assessment, as well as assurance from NHS North West that they meet my right hon. Friend the Secretary of State for Health’s four tests for service change: the proposals must demonstrate strengthened public and patient engagement; be based on sound clinical evidence; there must be support from GP commissioners; and there must be consideration of patient choice.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

It is marvellous how the right hon. Gentleman repeats his soundbite every time he discusses the NHS. I have to tell him that he is wrong. He knows that the NHS has to evolve. He knows that we have to improve and enhance patient care. I think he does himself a disservice by simply joining the ranks of organisations such as 38 Degrees, which is frightening people and getting them, almost zombie-like, to send in e-mails.

[Helen Jones (Warrington North) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.

[Helen Jones]

Is the Secretary of State aware that plans to remove vascular services from Warrington hospital will threaten services such as diabetes care, renal cancer care and the co-operation on stroke that has been built up with Whiston hospital? What will he do to protect those services, or is this part of the plan he discussed in February with NHS North West to reduce the number of acute beds and increase competition?

[Mr Lansley]

I am glad that on Monday the hon. Lady will have an opportunity for an Adjournment debate where this subject can be—

[Helen Jones]

Answer the question!

[Mr Lansley]

I will of course answer the question. The answer is that this is entirely driven by clinical issues in a local context. I can tell the hon. Lady that it is very much about trying to improve vascular services, and the judgments being made are local and clinical.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Burns]

No, I do not recognise that, because the figure that the right hon. Gentleman has used is an upper calculation, not an actual figure. I say to him that we are making efficiency savings, and that trusts should be cutting not front-line services but inefficiency, waste and excessive management, and reinvesting every single penny in front-line services.

[Helen Jones (Warrington North) (Lab)]

6. What steps he is taking to ensure that patients receive accurate and unbiased information on treatment options.

[The Minister of State, Department of Health (Paul Burstow)]

The NHS constitution gives people a right to information about their treatment options. I want everyone to get timely, trustworthy information such as patient decision aids, so that they are involved in their care decisions. The Health and Social Care Bill will ensure that the commissioning board and clinical commissioning groups secure that.

[Helen Jones]

In the light of that answer, will the Minister condemn the decision by GPs in Haxby to use NHS data to tout the services of their own private company and give wrong information to patients? Or is that simply a foretaste of what will happen under the Health and Social Care Bill when clinical commissioning groups decide what services are necessary, leaving private companies in which they may have an interest to pick up the slack in a privatised, marketised NHS in which patients come last?

[Paul Burstow]

The hon. Lady is spreading yet more myths and misconceptions about the reforms that this Government are making. If she had researched the matter more thoroughly, she would know that there is a code of conduct for the promotion of NHS-funded services, which makes it clear that providers of primary medical services cannot directly or indirectly seek or accept from any of their patients payment or other remuneration for any treatment. As a result, the PCT is questioning that clinic about how it has used patient information and will continue to pursue the matter.

Health and Social Care (Re-committed) Bill

Helen Jones Excerpts

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

I rise to support the Government’s amendments and to explain the Government’s thinking on the amendments tabled by Opposition Members and other Members in the House. This large group of amendments covers a range of key clauses that enable us to deliver on a number of key tenets of the Bill: first, an NHS led by clinicians; secondly, an NHS with quality at its heart; thirdly, an NHS that is open and collaborative; and, fourthly, an NHS with clear, stronger political accountability. It is on the last point that I would like to start my remarks today.

The role of the Secretary of State has been the subject of great debate, especially in recent weeks. It is right that we should have this debate and it is a very important issue, especially given its particular complexity, but let us ensure that the debate is based on the facts. Too often, opinions have been offered and accusations made without full knowledge of what the Bill does and does not do.

Let me start by clearly setting out what the Bill does not do. First, it is absolutely not the Government’s intention in this Bill to allow the Secretary of State to wash his hands of the NHS. The Government believe in a comprehensive, tax-funded NHS that is free at the point of use, based on need and not ability to pay. Nothing in this Bill will change that. Secondly, I want to reassure hon. Members that there is no question but that the vast bulk of NHS-funded health care will continue to be delivered by NHS bodies that are bound by law and their constitutions to remain as public sector bodies and to fulfil a primary duty of providing services to the NHS. Indeed, the Bill contains a new provision—for the first time—specifically to prevent any future Secretary of State or NHS bodies from acting to promote the private sector over the public sector.

Let me turn to what the Bill does. It ensures not only that the Secretary of State will remain politically and legally accountable for a comprehensive health service but that he will retain the capacity to intervene where necessary to ensure that a service is provided.

Let me start with the accountability of the Secretary of State. Not only does the Secretary of State retain a raft of specific duties that mean he cannot wash his hands of the NHS but the Bill retains the legal requirements that services should be free of charge except where already specified. It now includes requirements, too, on securing continuous improvement in the quality of services, on promoting research and the use of evidence learned from research and, for the first time ever, on the need to have regard to the need to reduce health inequalities.

[Helen Jones (Warrington North) (Lab)]

Will the Minister explain to the House why, rather than providing a duty to act to reduce health inequalities, the Bill requires bodies only to have regard to health inequalities? It is quite possible to have regard to them and to do nothing to reduce them.

--- Later in debate ---

[Paul Burstow]

That anxiety was expressed in Committee by some Opposition Members. As a result of the NHS Future Forum’s recommendations, we have put in place further checks to ensure that those concerns are allayed. Not least of those—as well as our view that the health and wellbeing boards should have on them a majority of elected councillors—is that they will have clear rights of membership from the local healthwatch, which will be listening to the wider community and will represent those wider concerns. They will have the views and expertise of the director of public health, the director of adult social services and the director of children’s services. If they feel that the strategy that they have all agreed is not being honoured in the commissioning strategy, they can ultimately refer that matter to the NHS commissioning board, and that can lead to changes being made.

[Helen Jones]

Many of us are concerned that we will not know properly what is going on in CCGs, because there is no requirement for them to be subject to the Public Bodies (Admission to Meetings) Act 1960 and to meet in public. They can decide whether to meet in public. How on earth is accountability to be maintained if those bodies can decide in private—[Hon. Members: “No, they can’t.] Yes, they can. They can decide in private how they will consider input from the health and wellbeing boards, and what they will do about it. Where is the line of public accountability?

[Paul Burstow]

I fear that, unfortunately, the hon. Lady might well have dusted down an old copy of the Bill, before the Future Forum made its recommendations and we made amendments to make it absolutely clear that a CCG’s governing board must meet in public. That is the decision-making body. Moreover, we also require those boards to set out in detail and publish all their decision-making arrangements—unlike PCTs, whose decisions could be made in private and no one would know.

Let me move on to health and wellbeing boards influencing commissioning decisions. Other people have questioned why we should have a quality premium at all. Indeed, amendment 1199 would remove the NHS commissioning board’s ability to reward CCGs financially for the quality of services—I emphasise that—and the outcomes that they secure, or reductions in health inequalities, which is something that all hon. Members across the House want to be promoted. That is the basis on which we want things to move forward, and high-quality services should be recognised and rewarded.

With amendments made in the second Bill Committee, we made it absolutely clear that such payments will provide an incentive to CCGs to focus on improving quality and outcomes. We will work with patients and professional groups to draft the regulations to reinforce that clear undertaking, which was made as a result of listening.

--- Later in debate ---

[Owen Smith]

I am grateful to the Minister for his contribution. Questions about the Bill just keep coming. That is how I feel on rising to speak. We have had eight months of debate on it. So far, more than 1,500 amendments have been tabled and we have learned today that more are coming, which was news to us at least. We have two—soon to be three—versions of the Bill, as well as a very real issue between Ministers and the Opposition over how it ought to be interpreted and what tone we ought to take when debating it. I would like to address some of those questions and talk about the tone. I also want to outline how we are interpreting the Bill and state that we feel very sincerely that the Government are misrepresenting what is in it.

By way of illustration, I shall pick up on a few things that the Minister said, which I feel either raise further questions or misrepresent what is in the Bill. I want to discuss in particular the issue that was debated by him and my hon. Friend the Member for Warrington North (Helen Jones)—whether, under the aegis of the Bill, the meetings of CCGs are to be held in public. He was very clear about that. In fact, he was so clear that he had his Liberal Democrat friends bouncing up and down, shouting, “Must, must! They must meet in public. Haven’t you read the Bill?” He went on to suggest that my hon. Friend had perhaps read an earlier iteration of the Bill. I know her well enough to know that she does her homework and she will indeed have read the second version of the Bill. There have been so many that it is quite easy to lose track. She will also have read schedule 2 of that Bill, which states—I will quote directly; I will not just make it up, like the Minister—

“The provision made under sub-paragraph (3) must include provisions for meetings of governing bodies to be open to the public, except where the consortium considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting.”

Meetings will therefore be held in public unless the consortium decides on a whim that it is not in the public interest for the public to come to the meeting—that is, for the meeting to be held in public. That is the tone that Ministers have set throughout the Bill. It is misrepresentation. It relies on the fact that there are thousands of words, acres of clauses and endless amendments. Ministers are trying to bore people into failing to look at the details, but I am far too much of an anorak; I will keep reading the Bill, keep looking at the amendments and keep drawing them to the public’s attention.

[Helen Jones]

Does my hon. Friend agree that experience shows that when bodies are left to determine when it is in the public interest not to know what is going on, they usually do so on the basis of what would be embarrassing to them? Does he not fear that when difficult decisions are to be taken, commissioning groups will shut down public debate by making their meetings not open to the public?

[Owen Smith]

One needs to look at the top of institutions in this country—at the Government, and the extent to which Governments of all stripes choose what they are going to reveal to the public and what they deem not to be in the public interest. That standard is set and applied throughout public and private bodies in this country and elsewhere.

I have no doubt that there will be many instances when CCGs will determine that it is not in the public interest that the public be admitted to their meetings—in particular, for example, when they are discussing hospital reconfigurations or closures, and changes to public services that people consider to be vital in those areas. CCGs must consider all those crucial issues, but they must do so in a transparent manner, which is what we said in Committee last time round, on the previous iteration of the Bill. We have said it again and the Government still have not answered the point to our satisfaction. I call upon the Minister to amend schedule 2 once more. There is time to do so in the other place and he may well want to give that consideration.

Health and Social Care (Re-committed) Bill

Helen Jones Excerpts

Tuesday 6th September 2011 Commons Chamber

[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.

Health and Social Care Bill (Programme) (No. 2)

Helen Jones Excerpts

Tuesday 21st June 2011 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that it is disgraceful that we are not even seeing those amendments until two days before the Bill goes into Committee, giving outside organisations and members of the Committee no time to scrutinise them? Does that not show that the Government are running scared of proper scrutiny?

[Mr Jones]

My hon. Friend makes a good point. One innovation is the introduction of pre-legislative scrutiny of Bills by a Committee. In 2001, I served on one of the very first such Committees, which considered the Civil Contingencies Bill. That was an extremely good process during which the then Government accepted well over 100 recommendations and amendments. With a timetable of 10 sittings—not 10 days, as the Prime Minister said today—there will be very little time for outside bodies to scrutinise and have professional input into the Government’s amendments.

The hon. Member for Southport (John Pugh), who speaks for the Liberal Democrats, says that we cannot prolong the agony or uncertainty faced by the health service. I remind him that we are in this position because his party is supporting the back-of-a-fag packet proposals dreamed up by the Secretary of State for Health. If he really wants to be able to say that he has made a difference, he should have voted with the Opposition when he had the opportunity. It is interesting that he is again the sole Liberal Democrat on the Government Benches, even though we are being told that it is the Liberal Democrats who have made major changes to the Bill.

If the Bill is to get proper scrutiny, if we in this place are to get the respect of electors in thinking that we are doing a proper job of scrutiny and, more importantly, if we are going to get the health service that this country deserves, this is not the way to do it. I predict that we will get to 14 July, when most of the amendments will not have been debated, and once again let the other place dismember the legislation. We can see the job it is doing up there at the moment, and that is because ill-thought-out and ill-prepared Bills are being brought forward by this coalition Government.

Points of Order

Helen Jones Excerpts

Tuesday 21st June 2011 Commons Chamber

[Mr Speaker]

I note what the hon. Gentleman has said, and I think that the House will have noted it as well. I do not think I need to add to what he has said, but I am nevertheless grateful to him.

[Helen Jones (Warrington North) (Lab)]

On a point of order, Mr Speaker. We shall shortly be considering a very important motion on the recommittal of the Health and Social Care Bill, and I understand that the Secretary of State for Health is not going to be here to move it and be questioned on it. Have you had any communication from the Secretary of State about his presence or otherwise, or has he simply resigned or gone out looking for another job before he is pushed?