Oral Answers to Questions

Jamie Reed Excerpts

Monday 12th May 2014 Commons Chamber

[Norman Lamb]

Given that time is tight, I simply confirm that I strongly support what Earl Howe said in the other place, and reinforce the points that my right hon. Friend has made.

For NHS trusts, clause 118 already requires the Secretary of State to produce guidance on seeking commissioner support and involving NHS England, and we will ensure that the key principles of parity between affected commissioners and the essential services they commission are captured in the guidance. I urge the House to support the Lords’ amendments.

[Mr Jamie Reed (Copeland) (Lab)]

Our amendments to Lords amendments 40B and 40C are designed to protect patients, improve transparency and decision making, and ensure that health service reconfigurations do not result in a restriction of access to services for patients. I give notice that I wish to press amendments (a) and (b) to Lords amendment 40B to a vote.

This is probably the final piece of health legislation that will come before this Parliament. To date, this Bill marks four years of chaos and confusion in the NHS—chaos inflicted on the service by the Prime Minister and his two Secretaries of State for Health. What a four years it has been! The Prime Minister promised no top-down reorganisation of the national health service, then introduced the biggest and most chaotic, expensive and wasteful reorganisation that the service has seen in its entire history. He promised a bare-knuckle fight against hospital closures—a fight that not only never appeared, but was knowingly untrue from the outset. We have seen Ministers admit that the 111 service was not ready to be rolled out, but who went ahead, scrapped NHS Direct and rolled it out anyway. We have seen one of the most important schemes for the future of the country and the NHS in the shape of the care.data scheme being bungled, botched and brought to the brink of collapse by ministerial incompetence. We have seen military hospital field tents outside accident and emergency units and police cars being used as makeshift ambulances, queuing outside hospitals for hours on end.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

My hon. Friend mentions the supposed attack on bureaucracy by the Conservatives. Is he aware that since their reorganisation there is actually more bureaucracy? Many of the people who have been sacked, and who received redundancy payments, are now working in the commissioning support organisations.

[Mr Reed]

My hon. Friend is entirely right, and the Lords amendments will only make that situation worse.

Now, as this zombie Parliament limps towards the finishing line, we are asked to consider a Frankenstein Bill—a badly stitched together Bill—which began with good intentions, but which, for the most part, will not end well. The Care Bill should have remained just that. On the face of it, part 1, building on the work of the last Labour Government, makes some modest improvements which we welcome, but let us be under no illusions. For all the Government’s bold claims, this Bill is a modest Bill. We support the rights for carers and many of the provisions and principles contained in part 1. Even though we believe that these could have gone much further towards the creation of a properly integrated model of whole person care, the real issue is that the Government have hijacked the Bill to push through a back-door reconfiguration tool that undermines the principle of local commissioning by centralising hospital closure and service removal decisions. It exposes as a sham the Government’s rhetoric about local clinical commissioning over the last four years.

Before I address the trust special administrator clause in more detail, let me touch on Lords amendment 11B, relating to human rights. Hon. Members may remember this issue from our debates on Report. The amendment will ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings.

This measure has a long history. In the other place, Lord Low tabled and passed a new clause which sought to close the loophole. But the Government removed it in Committee in this House, and then voted down an Opposition amendment on Report that would have restored it. The Minister did, however, say that he would go away and look at the issue again. The result is the amendment that we have before us today. For our part, we welcome the Government’s U-turn on this. It is good that Ministers have seen the light, having voted against this kind of protection at every previous stage of the Bill’s passage.

The amendment is clear that any care that is paid for out of public money

“directly or indirectly, in whole or in part”,

or which is arranged by a public authority, will now be covered by the Human Rights Act. However, I have a couple of questions for the Minister. First, he knows that personal budgets are absolutely critical in giving people greater choice and control over their lives, and enabling people to make their own decisions about how their care is delivered. It is important that personal budgets are covered by the amendment. Will the Minister confirm that that is the case, and that social care provided by a regulated provider and paid for by direct payments is included?

Secondly, it would be good if the Minister could clarify for the House whether so-called non-personal care is covered by the amendment. The definition of care used in the Lords amendment is that used in the Health and Social Care Act 2008. This is quite a narrow definition, and it is possible that it could exclude some very important types of care for people with learning disabilities or mental health problems, such as assisting them to participate in activities or to get to appointments. The Opposition amendment tabled on Report, which was drafted by the Joint Committee on Human Rights, would have covered this non-personal care, but as the Government’s amendment contains a narrower definition, we are concerned that they may be excluding quite broad categories of publicly provided social care services that may not be defined as personal care. We would be grateful if the Minister could allay our fears on that point, and confirm that those extremely important types of care for some very vulnerable people will be covered by this amendment. I look forward to his reply.

[Kate Green (Stretford and Urmston) (Lab)]

This is an important point for disabled adults in residential care, for example, who may receive care from one private provider, but access other services and facilities through another provider. Does my hon. Friend agree that it is important that all activities, including going out to participate in social and learning activities, need to be covered by the Lords amendment?

[Mr Reed]

Indeed. My hon. Friend knows about these issues in detail. That is why we have asked the questions that we asked and tabled our amendment on Report.

With reference to parts 2 and 3 of the Bill, the insertion of the hospital closure clause—the Lewisham clause, clause 119, formerly clause 118, call it what you like—is extremely regrettable. It is because of this that the comparison with Frankenstein’s monster has been made, and because of this that we have tabled further amendments today. This House, the people of this country and every hospital league of friends, local hospital action group or other such groups working for the benefit of health services local to their area—and I include in that the magnificent campaigners in Millom and around the West Cumberland hospital in Whitehaven —will never forget the genesis of the major policy change that this clause represents, namely Ministers’ attempts to close good services at a well performing hospital against the wishes of the locally affected public, patients and local clinical commissioners.

On attaining office, the Government made a series of grand promises about future changes to hospital services. The coalition agreement stated:

“We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.”

GPs were meant to be placed in decision-making roles and given the power to shape local services. As with so much that this Government do, the rhetoric could not be further from the reality, and far from stopping centrally dictated closures, they are now legislating to make it easier to close local hospitals and remove hospital services.

Clearly, a failure regime is essential and when things go wrong, they must be put right, but to attempt to short-circuit the existing reconfiguration framework, and to actively seek to disfranchise patients and the public, is not the way to improve services. Riding roughshod over local commissioning in order to reconfigure an area’s health services is not the way to build support for change. Deliberately ignoring the voices of local patients is a recipe for more expense, uncertainty and delay.

Take the example of Lewisham. Much has been said in this place about the process, the legal judgments and the amazing work undertaken by local campaigners there, so I shall not go into too much detail. Suffice to say that the Government’s attempts to use the law for a purpose for which it was never designed were described as “strained and unnatural” by Lord Justice Sullivan when dismissing the Government’s appeal against their original defeat. I would be grateful if the Government could explain why they believe the most effective way to deal with a failing trust is to alienate local commissioners, the local community and local health professionals. Rather than bringing stakeholders to the table to form a solution with regard to Lewisham, the Secretary of State dragged them through the courts and lost, twice.

Having been beaten by the law, the Secretary of State has decided to change it. The simple truth of the Government’s hospital closure clause is that a successful local hospital, the type that the Secretary of State enjoys getting his photograph taken in, can be closed without due process, simply because the one down the road is in trouble. It is as logical as removing a patient’s leg to cure a headache. Despite their valiant defence of the clause as it stood on Second Reading, the Government have been forced to make what they call major concessions, which are in reality very minor concessions.

Lords amendments 40B to 40E seek to ensure that “essential services” are not harmed. We are told this would mean that if a local commissioner believed that the trust special administrator’s recommendations would harm essential services, they would not be implemented—unless, of course, NHS England overruled the local commissioner. Our amendments to Lords amendments 40B and 40C would ensure that any recommendations would not be able to go ahead if they in any way restricted access to services, and that all correspondence between commissioners and the trust special administrator would be made public. Making it harder to use services is the very antithesis of the principles underpinning the NHS, which the Government claim to support—but only when it suits them.

We should judge this Government not by their words, but by their actions. They promised no top-down reorganisation. They delivered the biggest, most wasteful, most expensive and chaotic reorganisation in the history of the service. They promised a bare knuckle fight to protect local services. They delivered a back-door reconfiguration tool that could facilitate the largest ever hospital closure programme. They promised that local decisions would be made by local commissioners. They delivered a power for the Secretary of State and NHS England to overrule local commissioner vetoes. All this was done against the advice of medical professionals, against the wishes of the public and against every pre-election promise, and therefore without a shred of legitimacy.

The TSA process was introduced in 2009 and was intended, as the High Court ruled, to be used to make quick changes to management structures in order to address financial failures, not to make widespread service reconfigurations possible without public input.

[Paul Burstow]

Will the hon. Gentleman give way on that point?

[Mr Reed]

I will make some progress.

The only way to build sustainable services is to have widespread ownership of changes and a robust process of community engagement. The Government’s disfigurement of the TSA process will mean that they have to give no regard to patients’ wishes, and in practice it will mean that they can disregard the views of local commissioners. If the Secretary of State wants to close a hospital, it will be done. It is as simple as that.

In 2003 Labour created the independent reconfiguration panel, a non-departmental body to advise on service change. The IRP’s terms of reference when reconfigurations are proposed state:

“The panel will consider whether the proposals will provide safe, sustainable and accessible services for the local population, taking account of:

1) Clinical and service quality

2) The current or likely impact of patients’ choices and the rigour of public involvement in consultation processes, and

3) The views and future referral needs of local GPs who commission services, the wider configuration of the NHS and other services locally, including likely future plans.”

Why does the Minister think reconfigurations of whole health economies should not be subject to independent scrutiny by the IRP? Why does he think that this should be bypassed without local agreement? Given that quality issues are subject to a number of investigations before a TSA would be appointed, such as Care Quality Commission investigations and being placed in special measures, why cannot a thorough investigation of reconfiguration options be put to the IRP and the public?

If the point of centralising a reconfiguration decision is to provide a quick solution, why are not the Government open to consultation with the public on the future of their local health services during the process of inspection by the CQC or the extended period of time during which a trust is in special measures? Speedy resolution of care failures is essential, but to go along with the Government’s proposals would be to suggest this sense of urgency appears only after months of work trying to address the problem. That is wrong, and it is little wonder that so many hospitals and so many communities believe that this legislation is setting them up to fail.

The Government’s position on this is intellectually dishonest. In reaching the conclusion that the TSA process should be hijacked to provide a back-door reconfiguration tool, they have wilfully ignored professional, legal and medical advice, and have disregarded existing procedure. They have cost the taxpayer hundreds of thousands of pounds in defending their decision in the courts and they have added to the chaos into which they have already plunged the NHS. On Report we offered to work with the Government on a cross-party basis to produce a reconfiguration process and a TSA process that would have commanded broad public and political support. This offer was rejected.

The Opposition’s amendments seek to make a bad law slightly better, but the truth is that more lifeboats on the Titanic would not have stopped it sinking. In case any Government Members ever actually believed the coalition agreement, a vote against our amendments today is a vote against that agreement. At their heart, our amendments are an attempt to help the Government to help themselves, but more importantly, to help all of those communities who expect to have a say in the future commissioning of their local hospital services. The next Labour Government will ensure that their voice is heard.

[Paul Burstow]

Listening to the hon. Member for Copeland (Mr Reed), it struck me that the Care Bill could be described as a Bill that was full of ideas that were proposed by the Labour party when it was in government, but was a modest measure. In some ways, I find those two positions contradictory, unless of course the last Government were not the bold, revolutionary Administration whom they often told us they were when they were in office. If we are indeed in a zombie Parliament, that is characteristic of the languid nature of opposition offered by the Labour party.