Oral Answers to Questions
Debate between Jamie Reed and Paul Burstow(10 years, 7 months ago)
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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.
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.
Oral Answers to Questions
Debate between Jamie Reed and Paul Burstow(12 years, 8 months ago)
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Mr Jamie Reed (Copeland) (Lab)
When I last asked the Minister from the Dispatch Box about the loss of 3,500 nursing posts, he told the House that that was “factually incorrect”. He was right, and I apologise: the actual figure, published last week, is 4,096. In what will surely be one of the Secretary of State’s final outings in his current post, before he is reshuffled to where he can do no further harm, will he tell the House how many of those nursing posts would have been secured by the £500 million spending cut he agreed with the Treasury in last week’s Budget?