Health and Social Care Bill

Debate between Henry Smith and Nick de Bois

Monday 31st January 2011 Commons Chamber

[Nick de Bois (Enfield North) (Con)]

I am very grateful for this opportunity to contribute to the debate. It is a great relief to note that we are now having a debate, having passed the stage where people, such as the previous Government, believed that pouring in more money improved outcomes. We are now debating reform, and we should welcome its scale, so that we can head towards what patients want—improved outcomes.

Whatever the good intentions of the previous Government, there is no question but that, unfortunately, their measures led to reduced productivity, a massive increase in bureaucracy and a distortion of clinical priorities, which meant that, on the outcomes that we seek, patients were not satisfied. I have been more concerned about health outcomes and the fact that patients were becoming remote from the thing that mattered to them most. That is what the NHS is about. Whom do patients trust? Do they trust a remote primary care trust or their local doctor? There really is no contest, so I welcome these reforms, because they will give commissioning powers to GPs and bring their patients closer to the decisions about their future.

I do not recognise the picture painted by Opposition Members who say that GPs do not welcome the proposals. Already more than half the country is working under the pathfinder shadow consortia, and in Enfield we are already rushing to sign up. We have agreed our consortium, which I warmly welcome. It is keen to seize the opportunity.

Let us turn to local accountability, which goes hand in hand with local commissioning-based services. In the past, it has proved impossible to have genuine local accountability as the NHS processes ultimately all led directly to Whitehall and the Secretary of State. I agree with the Nuffield Trust that the widening involvement of independent providers, the use of social enterprises and community services, and the increase in foundation trusts mean that local accountability mechanisms should indeed be robust.

The right hon. Member for Croydon North (Malcolm Wicks), who, sadly, is not in his place, and the hon. Member for West Lancashire (Rosie Cooper) expressed concerns that the mechanisms would not be robust, but I refer them to clause 170, on independent advocacy services, and to clause 175, which emphasises the scrutiny role of the local health authorities, not to mention the local representation of councillors. [Interruption.] The hon. Member for Leicester West (Liz Kendall) says, “One” from a sedentary position, but I shall not take lectures from a member of a party whose Government carried out no consultation as they tried to reconfigure services in Enfield against the wishes of the public. I shall turn to that now.

It makes no sense that the people who want to hold the health care community to account for their local services should have to go to an intransigent bureaucracy and ultimately up to the Secretary of State. That process is removed from where the local decision making takes place. As I said, in my constituency we are reaching a critical stage now in the future configuration of our acute hospital services. The decision prompted by the previous Government, to downgrade and rip out our vital A and E service and axe the consultant-led maternity services that see 3,000 births a year, is being relentlessly pursued by those same bureaucrats and officials from the health services, despite the fact that the decision will cost lives.

In ignoring the wishes of thousands who took to the streets and the view of the majority of Enfield GPs, those same PCT officials, even at this late hour, are effectively trying to bully the residents into accepting the changes without the consent or consultation of the people. No such arrogance would have been evident if this Bill had been in place. Local people would have been engaged in a genuine process of change because such a proposal would have had to have been agreed by the local health and wellbeing board. As the Secretary of State said yesterday morning, any possible future changes would have to be agreed in the health and wellbeing board of the local authority, which is publicly open and accountable. Gone is the “Whitehall knows best” attitude, to be replaced with local accountability, local engagement and local decision making.

Had the Bill been in place as law, I do not believe that we would have reached the 11th hour for this critical decision in Enfield. The four tests that the Secretary of State rightly requires would have kicked the issue into touch long ago because of genuine local accountability. The local authority, local GPs and, above all, local residents have spoken with one voice. I am grateful that we have a Secretary of State who believes in local accountability and decision making. In future, the voice that was ignored by the Labour party will be enshrined in this legislation. For years, we have suffered from a lack of local accountability in the health service.

[Henry Smith]

Had the Bill been law 10 years ago, Crawley hospital would not have lost accident and emergency and maternity services. It seems that my hon. Friend thinks the same about hospital services in his constituency.