Health and Social Care Bill Debate
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John Healey
Main Page: John Healey (Labour - Rawmarsh and Conisbrough)Department Debates - View all John Healey's debates with the Department of Health and Social Care
(13 years, 10 months ago)
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John Healey (Wentworth and Dearne) (Lab)
The Health Secretary is a man who is struggling to sell his plans. The more people learn about them, the less they like them. The more those in the NHS see, the more worried they become and the less they find to support. Only one in four of the public back him in wanting profit-making companies to be given free access to the NHS. Most GPs neither like nor want these changes, and three out of four doctors do not believe that they will improve services to patients.
Today, for the second week running, the Prime Minister is talking about the NHS changes. He is like a football club chairman stepping in to back a beleaguered manager because everyone else is losing faith in the manager’s judgment. Mind you, the Prime Minister does not always help the Health Secretary, because his words do not ring true with people. Last week, the Prime Minister called the NHS “second rate”. People know that it can be better, but they are proud of the NHS. They have seen big improvements during the last Labour decade, and they know that waiting lists are at their lowest ever and that patient satisfaction is at its highest ever. Those facts are backed up by international comparisons from the Commonwealth Fund, which said last year that Britain’s NHS is one of the very best in the world, and second to none on best value for money.
Nick Boles (Grantham and Stamford) (Con)
The Labour Government introduced foundation hospitals, private sector provision in the NHS, patient choice and payment by results—four things on which we are now building. They also introduced GP commissioning through pathfinders. Which elements of the Blair reforms to the health service is the right hon. Gentleman not repudiating today?
John Healey
It is true that we encouraged many of the GP commissioning models that the Health Secretary now champions, but that process was always within a planned and managed system, and it was never implemented at the expense of other clinicians or patients being in charge. We used private providers when they could add something to the NHS and help it to raise its game, and when they could add capacity so that we could clear waiting lists. Of course there is a role for them in the future, but that is not the question at the heart of the Bill. I will come back to the hon. Gentleman’s question later, however. People saw big improvements in the NHS under Labour, but they now realise that many of those gains might be at risk as a result of the decisions that this Government are taking.
David Miliband (South Shields) (Lab)
Does my right hon. Friend agree that the most significant change in the Bill was not mentioned by the Secretary of State? It is that the Bill introduces price competition into a market that, up to now, has allowed competition only on quality. The London School of Economics, citing academic evidence, states clearly that
“most international evidence suggests that, whereas hospital competition with fixed prices can improve quality, simultaneous price and quality competition can actually make things worse”.
John Healey
Characteristically, my right hon. Friend is absolutely right. These changes to the NHS and the Bill—[Interruption.]
John Healey
I shall answer my right hon. Friend the Member for South Shields (David Miliband), then I will give way.
My right hon. Friend is absolutely right. The Government will talk about some changes, but not about others. The changes are like an iceberg, with big, substantial, ideological changes hidden from public sight.
Mr Lansley
The edifice of an argument from the right hon. Member for South Shields (David Miliband), which is repeated by others, is based on one fact: in December 2009, the operating framework said that commissioners in the NHS could set a maximum price and not just a fixed price. That was December 2009. The right hon. Gentleman and the shadow Health Secretary were in the Government who put that measure into the operating framework. This Government did not put it in; the previous one did.
John Healey
The point made by my right hon. Friend the Member for South Shields is based on page 42 onwards of the Health Secretary’s impact assessment of the Bill, which mentions a premium for private providers of £14 per £100. The Bill allows the system to pay a premium and a bung to private sector providers.
Mr Stephen Dorrell (Charnwood) (Con)
Will the right hon. Gentleman now answer the question put to him by my right hon. Friend the Health Secretary? Does he agree or disagree with the maximum price tariff principle that was set out in December 2009 by the previous Labour Health Secretary?
John Healey
We operated an NHS with a set tariff, not a maximum tariff. In government, we operated an NHS in which price could not be the factor that drove decisions about what services patients received and by whom they were provided. My right hon. Friend the Member for South Shields is absolutely right to point out that the Bill will introduce price competition and the flexing of the price so that there is no longer a set tariff for treatments and patients but a maximum price that can be undercut by providers coming into the field. The Government will not talk about that.
The Prime Minister is not helping the Health Secretary, because the changes the Bill makes were not in his election manifesto, not on his election posters and not in his election speeches. I have the Conservative manifesto here. There is no mention of axing all limits on NHS hospitals treating private patients, so that NHS patients lose out; no talk or mention of undercutting on price, so that established NHS services are hit as new private companies cherry-pick easier patients and services; no mention of guaranteeing only selective hospital services, so that others can be closed and lost to local people without public consultation; and no mention of putting a new market regulator at the heart of the NHS with the principal job of promoting and enforcing competition. There is no mention in the Conservative manifesto of the biggest reorganisation of the NHS since it was set up more than 60 years ago. They did not tell people about their plans before the election and they promised not to introduce such measures in the coalition agreement after the election. There is no mandate from the election or the coalition agreement for this fundamental and far-reaching reorganisation. That is not a debating point, but a point of democratic principle.
Gordon Birtwistle (Burnley) (LD)
I do not remember in the 2005 Labour party manifesto the “Meeting Patients’ Needs” programme that closed the A and E unit and the children’s ward in Burnley. Do not start getting on to us about what we are and are not closing. The right hon. Gentleman closed those things. Does he agree that what he did was a disgrace to the people of Burnley?
John Healey
May I urge the hon. Gentleman to look very closely at the Bill and beyond what he hears the Health Secretary say when he talks about it? I urge him instead to look at how local hospitals could be undercut by private health companies, and at how GPs could be forced to put out work to those companies. That will undermine local hospitals such as the one in Burnley and lead to hospital closures driven not by proper planning and the development of better services in the community, but by hospitals being driven to the point of bankruptcy and closure.
Dan Byles (North Warwickshire) (Con)
The right hon. Gentleman does not seem to understand how the health service operated under his Labour Government. My constituents in Warwickshire have been suffering because NHS Warwickshire, under the rules we inherited from his Government, set up a fixed-price, below-tariff contract with one of the trusts in its area that has led to patients being drained from the George Eliot hospital trust in my area and the area of my hon. Friend the Member for Nuneaton (Mr Jones) to Warwick. It was Labour’s rules that allowed it to undercut the hospital in my constituency.
John Healey
If the hon. Gentleman was worried about the past, he should be a good deal more worried about the future, and, a bit like the Health Secretary, he should spend a lot less time talking about the Labour Government and what we did to the health service and more time talking about the plans and big changes to come.
Geraint Davies
Does my right hon. Friend accept that the core difficulty with the Bill is that it is not about patient choice but about a movement towards general practitioner choice and GP consortia choice? They want to maximise not medical outcomes but profitability. That is what this is about, and the reason is the same as what was said about flexible pricing.
John Healey
My hon. Friend is right. For the first time in the NHS we are facing, first, the potential for profit at the point of commissioning and, secondly, commissioning—in other words, decisions about rationing as well as referral—being made at the individual patient level, not at the collective area level, and we are looking at them being made by bodies and individuals who are not publicly accountable, including to the House.
Mr Lammy
My right hon. Friend is right to press the case about private providers. Is he surprised that the Secretary of State, in response to my question earlier, did not confirm to the House that the wife of John Nash, the chairman of Care UK, funded his office in November 2009 to the tune of £21,000? Does he think that the Secretary of State should put that on the record?
John Healey
I am surprised that the Health Secretary was asked a direct question and did not answer. I would simply encourage my right hon. Friend to keep asking the questions that he feels are important for the future.
Mr Andy Slaughter (Hammersmith) (Lab)
Mr Nash’s wife also bankrolled my opponent at the last election—for all the good it did him. However, something else was not in the Tory party manifesto, and that was cuts in the health service. I have in my hand a letter from the chief executive of my primary care trust that simply states that
“healthcare in North West London will face a £1bn shortfall in funding by 2014/15, given these upward pressures.”
Is that not something else that the Tory party did not tell the truth about, and something on which it is not following the Labour Government?
John Healey
My hon. Friend won his seat at the last election because he helped to expose the truth about the Conservative plans for housing—a truth that it denied but which has now come true. He is absolutely right. The truth about what is happening in the health service now is that patients are starting to see the signs of strain and services being cut, and that is not what they expected when they heard the Prime Minister, before the election and afterwards, promising to protect the NHS.
Andrew Bridgen (North West Leicestershire) (Con)
I thank the right hon. Gentleman for giving way. In my first two weeks as an MP, I paid a visit to the local PCT in Leicester, and in a meeting with the chief executive I asked how the PCT would cope with the immediate 35% cuts in management imposed by the coalition Government. The answer truly shocked me: I was told, “It will be no problem at all, because we have already increased our management by 50% in the past year.” Will the right hon. Gentleman accept that under the previous Government’s watch, the PCTs became the bloated bureaucracies that now need reforming?
John Healey
The problem for PCTs, and the managers and staff who work in them, is that they are being asked to do several things at the same time: to make unprecedented efficiencies at a time when the NHS is being put through its tightest financial squeeze in history; to axe its own jobs; and to guide the reorganisation and ensure that it can take place. That is a tough challenge for anyone. I am sure that the hon. Gentleman will keep on his local PCT’s case.
Andrew George
I am grateful to the shadow Secretary of State for giving way. I would accept his criticisms more openly—I think—were he prepared to acknowledge that the previous Labour Government set up independent treatment centres and rigged the market to hand over 15% of all elective operations in an area such as mine to an independent company that they more or less set up themselves, and which undermined the local acute trust and services with changes that patients had not asked for. That was forced on the PCT and not something for which it asked. It was a rigged market. Would he like to apologise to the House for the practices of the previous Labour Government?
John Healey
I am more interested in what we will be facing in future. I am more interested in the claim by the Health Secretary that there will not be, as he describes it, a rigged market in future, but a level playing field for all providers. However, my hon. Friend—[Interruption.] Well, we will see. The hon. Gentleman is a member of the Select Committee on Health, and he follows such matters closely. I urge him to read page 42 onwards of the impact assessment, because there he will see the preparations for being able to pay for the sort of thing that he criticises in the health service.
As the hon. Gentleman gives me this opportunity, let me say to him and his Lib Dem colleagues that what we are facing is clearly Conservative health policy, not coalition health policy, and certainly not Lib Dem health policy. The main evidence of any influence of Lib Dem ideas on health policy in the coalition agreement was the commitment to
“ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”.
The Bill abolishes PCTs. The Lib Dem policy priority before the election was to ensure that local people had more control over their health services. The Bill places sweeping powers in the hands of a new national quango—the national commissioning board—and a new national economic regulator, which is charged with enforcing competition, to open up all parts of the NHS to private health companies. The Lib Dems’ principal concern was to strengthen local and public accountability of health services, but the Bill seriously restricts openness, scrutiny and accountability to both the public and Parliament. It will lead to an NHS in which “commercial in confidence” is stamped on many of the most important decisions that are taken. I therefore say to the hon. Gentleman and his Lib Dem colleagues: this is not your policy, but it is being done in your name. The public will hold you—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I know that this debate is attracting a lot of emotion and generating a lot of heat, but will Members please try to speak through the Chair? I have been accused by both sides of doing many things in this debate, and I have not done any of them.
John Healey
I accept that correction, Mr Deputy Speaker. Let me put it in these terms. The policy is not Liberal Democrat policy, but it is being done in their name, and the public will hold the Liberal Democrats responsible if they allow the Tories to do this to our NHS.
Jeremy Corbyn (Islington North) (Lab)
Is my right hon. Friend aware that, in the rush to establish a GP commissioning system, PCTs are being merged, and that large numbers of highly skilled staff are disappearing quickly, as is the ability of PCTs to administer anything, and all this before the Bill has even received a Second Reading? Does he not think that the Secretary of State is culpable in the rapid disintegration and disorganisation of local NHS facilities all over the country?
John Healey
That is one of the things that worries experts and those in the health service the most. It is also one of the things that the right hon. Member for Charnwood (Mr Dorrell) and his Health Committee were most concerned about. [Interruption.] The right hon. Gentleman is nodding. “Disruptive” was one term that the Committee used for the changes.
Mr Dennis Skinner (Bolsover) (Lab)
Why on earth should the health service be changed? We had 13 years. We dragged the health service from the depths of degradation and hoisted it to the pinnacles of achievement. There was £33 billion in 1997; we increased that to £110 billion. All those miners in my constituency and that of my right hon. Friend who wanted those knees or hips replaced—they have all been done, after waiting not for five years, but for a few months. That is what I call achievement, and that is what the people in Bolsover and elsewhere know. That is why the health service was safe in our hands and why, they assume, this one on the Government Front Bench is now going to privatise it.
John Healey
Well, my hon. Friend is right in this respect: people will come to see clearly that they cannot trust the Tories with the NHS; they will come to see clearly what these changes really mean for their services; and they will come to see clearly what the future of the NHS holds.
John Pugh (Southport) (LD)
I cannot follow the previous contribution, but the right hon. Gentleman has mentioned democratic accountability, so will he accept that in 10 years of Labour government, nothing was done about democratic accountability in the NHS? We simply had rule by quangos.
John Healey
No, I do not accept that, but I will tell the hon. Gentleman that the measures in this Bill will undermine many of his principal concerns and policy priorities about opening up the NHS to the public and to Parliament. I hope that he will take a close look at what the Health Secretary really plans.
Alex Cunningham (Stockton North) (Lab)
I hope that my right hon. Friend will agree that the NHS is supposed to be about people and their health, so does he also agree that putting different parts of the health service in competition with one another will lead to fragmented and disjointed pathways of care and undermine innovation and the sharing of best practice, as well as increasing administrative and other costs with public funding being wasted on transaction costs?
John Healey
My hon. Friend is right—and the chief executive of the Patients Association, Katherine Murphy has said just that. Many patient groups are making the same arguments and issuing the same warnings.
My serious concern is that this Government have told only half the story from the start. The Health Secretary and the Prime Minister are happy to talk about GP commissioning and happy to talk about cutting management—the organisational changes—but they downplay or deny the deep ideological changes at the heart of these plans. The Health Secretary mentioned the new economic regulator, Monitor, in just one line in a speech lasting more than 40 minutes. The Prime Minister said last week in his speech on public services that these reforms
“are not about theory or ideology”.
The Prime Minister writes in The Times today, just as the Health Secretary did last week, both of them producing 700 words about their health plans, yet they made not a single mention of competition.
We will explain and expose the truth throughout this debate and the Bill’s passage through Parliament because these changes will break up the NHS; they will open up all areas of the NHS to price-cutting competition from private health companies; and they will take away from all parts of the NHS the requirement for proper openness, scrutiny and accountability to the public and to Parliament. These Government changes are driving free market political ideology into the heart of the NHS, and that is why doctors are now saying:
“As it stands, the UK Government’s new Bill spells the end of the NHS.”
John Healey
The public are being told that the reorganisation is “patient centred”, but patients are being sold a false promise on the NHS. The changes in the Bill come in only in 2013, but patients are already seeing the consequences of the Government’s handling of the health service. The Government have scrapped Labour’s waiting time targets, which were, of course, the patients’ guarantee of being seen and treated promptly. They are breaking the Prime Minister’s promise of a real increase in NHS funding, so Scotland is being short-changed next year by £70 million and Wales is being short-changed next year by £40 million. England, if we take out the double counting of cash to be spent on social care rather than on NHS services, faces a shortfall next year of £1.2 billion on the Prime Minister’s promise.
With this Bill, the Government are now breaking their promise to stop top-down internal reorganisations and they are putting extra unnecessary pressure on the NHS. Patients are starting to see waiting times rise; they are starting to see discharges from hospital delayed; they are starting to see wards mothballed and staff posts cut. That is not what people expected when the Prime Minister promised to protect the NHS. The Prime Minister’s most personal pledge to the public is becoming his biggest broken promise.
Nick de Bois
Will the right hon. Gentleman try to understand—[Interruption.] Perhaps he will. Members suggest that this is ideological. I do not see how it is ideological not to repeat the gross error of 2008-09 when, under the right hon. Gentleman’s watch, managers were recruited at five times the rate of nurses working on the front line—which is not ideological either, and does not serve patients.
John Healey
This is ideological. It is about driving politics into the heart of the NHS, and in some respects breaking what has been a 60-year consensus. Parties on all sides have tried to make decisions about the best interests of patients and better services, and not about their own political ideologies. That has changed today, with this Bill.
John Healey
I want to make a bit of progress before I give way again.
The public are being told that this reorganisation is patient-centred, but most patients’ GPs will not, in practice, be doing what the Government claim they will be doing. GPs spend an average of only about eight minutes with each patient. If they continue as family doctors, the commissioning will not be done by them; it will be done in their name by the managers in the primary care trust who carry out that function now, or by private health companies that are already hard-selling their services to GP consortia. Those consortia are being sold a false promise as well. Because expanded open-ended choice of treatment means funding unused capacity in the system, it is highly unlikely to happen at a time when NHS finances are under pressure.
Despite the boast about putting patients at the heart of everything that the NHS does, there is no place for patients on the bodies that will make the most important decisions on the NHS. There is no place for them on GP consortia, no place for them on the national commissioning board, and no place for them on the regulator, Monitor.
John Healey
The hon. Gentleman has already heard some of my hon. Friends mention the analysis of Dr John Appleby, published in the British Medical Journal online last week. He took to task those who had made the sweeping assertion that somehow Britain’s health service lags behind those of the rest of Europe. It is an argument that the Prime Minister advances. It is an argument for change, he says, because we are still a long way from European standards of care.
Let me read something to the House. We have been told that
“if you have heart surgery in England, you now have a greater chance of survival than almost any other European country – over the last five years, death rates have halved and are now 25 per cent lower than the European average.”
Those are not my words, or even those of Dr John Appleby. They are the words of the Health Secretary, published on ConservativeHome last week.
The Prime Minister argues that this is somehow an evolution and not a revolution. The Bill, however, is more than three times as long as the legislation that set up the NHS in 1948. The NHS chief executive told the Select Committee on Health:
“The scale of change is enormous—beyond anything that anybody from the public or private sector has witnessed”.
The Health Secretary argues that the Bill is somehow an extension of Labour policies. That is wrong, and it disguises again the fundamental changes to the NHS in the Government’s plan. Make no mistake, Mr Deputy Speaker: this is a revolution, not an evolution.
Jesse Norman (Hereford and South Herefordshire) (Con)
I note that the right hon. Gentleman failed to answer the question about the rate of increase in the number of managers. When I last checked, the NHS had 1.3 million employees, of whom almost exactly half were administrators and half were on the front line. Is he really willing to defend such an extraordinary level of overstaffing in management?
John Healey
Oh dear, the hon. Gentleman really has to get a better briefing from his Whips than that.
Clive Efford
Will my right hon. Friend confirm that in order to shoehorn private enterprise into the NHS, the regulations are being written to add a 14% premium into the tariff for private sector companies that will be tendering for work?
John Healey
My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.
Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.
If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.
Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.
Mr Anderson
In a disparaging comment earlier, the Secretary of State said that the voices of concern were the voices of the trade unions. They are led by people who were health professionals and they represent 1.3 million professionals. Surely somebody in this place should listen to what they say and not to Government Members, who have a biased reason for doing this.
John Healey
My hon. Friend is right. The more that NHS staff see of the changes and the consequences of this Government’s handling of the NHS, the more concerned they are about the changes and the more they are starting to see the NHS go backwards. But the Government will not listen to these warnings that are coming from all sides. They are in denial about the risks: the risk that patients will see services get worse, not better; the risk that up to £3 billion will be wasted on internal reorganisation; the risk that innovation and improvements in care that come from greater collaboration will be blocked by the Office of Fair Trading, competition courts and the new market regulator; and the risk that the Bill will create the monster of a full-blown market in health care which GPs will not control and nor will Ministers or Parliament.
If patients have been sold a false prospectus, that is true of GPs too. GPs are being told that they will call the shots on deciding who provides care for their patients, but they are being set up by the Government. They are likely to find their hands tied by Monitor and the Office of Fair Trading and by the courts enforcing competition law. They are likely to find their decisions challenged by private companies if they do not accept “any willing provider”, especially one that offers to undercut on price. The chair of the Royal College of General Practitioners recently issued a warning to her colleagues. She said:
“I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services”.
Because the reorganisation will force doctors to make rationing decisions as well as referral decisions for their patients, they will make treatment decisions with one eye on their patient and the other on their budget and their consortium’s bottom line.
The Government say they are devolving power to front-line services, putting clinicians in control, making the NHS more accountable and improving the integration and quality of services, but in the Bill they are making the forces of competition and centralisation far stronger than those of devolution, democratic accountability or the development of quality in patient services. We will explain and expose the gap between what Ministers are saying and what they are doing in every debate at every stage of this legislation.
Patients and staff are already seeing signs of strain in the NHS. They are starting to ask, “What on earth are the Government doing with the NHS? Why don’t they listen to the warnings? Why is the Prime Minister breaking the very personal promise he made to protect the NHS?” The Bill puts competition first and patients second. That is why we will oppose the Bill tonight and expose this truth in the months ahead. These are the wrong reforms for the wrong reasons at the wrong time.
Mr Stephen Dorrell (Charnwood) (Con)
I rise to support the Bill. The shadow Secretary of State started by saying that my right hon. Friend the Secretary of State struggled to explain his reasons for introducing the Bill, but I think that the shadow Secretary of State struggled to explain why he opposes it. He struggled from the moment that my hon. Friend the Member for Grantham and Stamford (Nick Boles) intervened to draw his attention to the fact that the Bill represents an evolution of policy that has been consistently developed by every Secretary of State since 1990, with a single exception in the form of the right hon. Member for Holborn and St Pancras (Frank Dobson), who sits on the Labour Back Benches. The question that the shadow Secretary of State has to answer is this.
Mr Dorrell
Let me pose the question and I shall be delighted to give way. Which of the key themes does the right hon. Gentleman oppose? Is it the practice-based commissioning or the “any willing provider” model? Is it the introduction of private sector expertise into commissioning, which was first articulated in the world class commissioning programme, or is it the principle of the maximum tariff? Let me help him by quoting from the operating framework of 2009, to which my right hon. Friend the Secretary of State referred. It states:
“After 2010/11, we shall move to a position where national tariffs represent the maximum price payable to a commissioner, as opposed to the mandated price for a particular activity.”
With which of those four key policies does the right hon. Gentleman disagree?
John Healey
The right hon. Gentleman started by saying that the policies are an evolution. If that is the case, why did he say:
“I thought we were looking to develop existing institutions rather than starting again, and that appeared to be confirmed in the coalition agreement.”
John Healey
The right hon. Gentleman, who is nodding, went on:
“Then in July that approach was changed. That came as a surprise.”
Mr Dorrell
Indeed it did. I offered the right hon. Gentleman four consistent themes of policy. He accurately quoted my comments about a specific element of bureaucracy. One of the questions that the Select Committee addressed was why, since all these broad themes are so broadly supported, we went down the road of replacing the PCTs with the consortia. That is a question that the Select Committee said in its report had not been adequately explained, but that is a relatively minor question of bureaucratic presentation when compared with the broad themes of policy that were articulated in the debate by my hon. Friend the Member for Grantham and Stamford. Which of these key policies does Labour now wish to dissent from?