Health and Social Care Bill

John Healey Excerpts

Tuesday 20th March 2012 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

Before my hon. Friend moves on, will she pay tribute to our Labour colleagues in the Lords, who have worked across the House, but who, by dint of the way the House of Lords works, cannot always claim credit for the results they have achieved by working in that way?

--- Later in debate ---

[Simon Hughes]

Let me deal with both those points. I acknowledge that absolutely. On past occasions, the right hon. Gentleman has been to our party conference, although I do not think he came to the Gateshead conference. [Interruption.] It appears that one of his colleagues did. There were and are concerns in my party about this. My party wrote the plan for the NHS, which the good Labour post-war Government implemented, so of course we think we are as much the proprietors of the NHS as his party and of course there are concerns. There are many concerns—many colleagues are not happy with the Bill—and I am owning up to that.

I am absolutely clear about that, but do not let the right hon. Gentleman misrepresent what happened at Gateshead. My party is a democratic party. It is more democratic than his, thank God, and much more democratic than the Tory party. Our party voted to commend the Lords for the work they had done, but to suspend judgment on the Bill. My party neither voted to say that the Bill should not go ahead, nor to decide that the Bill should go ahead. That was what the debate, in the end, was about. There was not quite a majority saying, “Stop the Bill”; that was not the view of the conference, although there are many people in our party, as there are in his—this view is also shared by some in the Tory party and elsewhere—who would want the Bill to be stopped.

The Bill is not going to be stopped; it will become law. The Bill contains many good things. My concern now is to reflect what constituents, both health professionals and those who are not health professionals, come to talk to me about. They feel that there is a need to get back to concentrating on the things that really matter, such as making sure the wards are clean; making sure that the staff are of the highest quality; making sure that the waiting times go down; making sure that we can get decent care for the mentally ill; and making sure that our NHS is able to do better on all that it does. That is what the concerns are.

I want to make sure that Ministers understand that once the Bill is on the statute book there should be no cause for rejoicing, because this is not a matter for rejoicing. It is a matter of a challenge for Government to go back in humility to the health professionals and say, “We may not have got it all right—we may have got some of it wrong—but we are willing to listen, to learn and to work with you.” In the end it is collaboration between local authorities, local councillors, local people, Ministers, parliamentarians and those millions of fantastic people who work in the national health service who will make sure that the health service survives. It will survive and prosper in this country as a public health service—thank God—and we must all work together to respond to concerns, alleviate fears and not fan the flames. We must make sure that from now on we work on the basis of facts, not fiction, and that we work with those who have the concern, like we do, that the NHS should survive and prosper.

[John Healey]

I had not intended to speak in this part of the debate but I was so underwhelmed and unimpressed by the Minister that I felt moved to do so. It is interesting to follow the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). I think he was offering his support to the Front-Bench team, but often it was not entirely possible to be certain. One thing he talked about was quite telling—the flaws in the systems we as a Government tried to put in place after we did away with community health councils. The Secretary of State and his colleagues were very critical about those arrangements when they sat on the Opposition Benches. One might have hoped that they would make their criticisms and learn the lessons and not repeat some of the mistakes that we certainly made in the arrangements for a strong patient voice and strong patient representation after the community health councils, but this evening’s debate and what we have been presented with in this final stage of the Bill make it quite clear that that is not the case.

At the heart of the proposal in the White Paper, which was co-signed by the Prime Minister and the Deputy Prime Minister in July 2010, was the proposition to put patients at the very heart of the NHS. That was common ground and was supported by many. It was a promise that really went to the heart of the proposition about the NHS changes. Despite that promise, it is clear that patients are not at the heart of the NHS but at the margins. The slogan for patients that there will be no decision about me without me is simply that—a slogan. I remember that early in the autumn of 2010 patient groups who were trying to come to terms with the plans were saying—quietly at first but more loudly later—that the arrangements in the White Paper and then in the Bill when it was first introduced in the House would lead to less involvement of patients in future, not more. Since that point, the Bill has had more than 1,000 amendments—some 374 amendments were made in the other place and we have four hours to consider those amendments tonight—but looking at the Bill now I can see very little difference from the position as it was first expressed almost 18 months ago, when it first caused concern to those patient groups.

In this area of all areas in which party politics should not be part of provision for a strong patient voice, representation and safeguarding, I want to take the Government at their word. They said that they wanted to set up at the heart of the NHS a strong independent voice for patients. The House needs to consider what that means, and to do that we need to go back to first principles.

It seems to me that there are four principles or characteristics which must serve as yardsticks by which to measure whether an organisation can be a strong, effective voice for patients. The first is independence. In order to function as a strong, fearless voice for patients, any organisation that acts on their behalf must be independent of commissioners, independent of providers and independent of regulators because part of its job on behalf of patients may well be to stand up to and criticise the providers, the commissioners or the regulators at some point in fulfilling its duties. The arrangements that the House is asked to approve tonight fail that first basic test of an effective organisation for patients.

The second principle or yardstick is representation. If the organisation is to be an effective representative voice for patients, clearly it must have some representation system and accountability to the people on whose behalf it acts and speaks. Again, on that test, the arrangements that we are asked to approve tonight fail. The third principle or test of an effective patient organisation is whether it is rooted or grounded in good local information and monitoring. Again, nothing in the arrangements and nothing I heard from the Minister, who has now left the Chamber in the middle of the debate that he opened, gave me any reassurance that that third principle or test is met in the arrangements.

The fourth test or principle for an effective, independent organisation surely must be adequate resources. There are serious questions over the nature, the level and the system for the resources that will allow such an organisation to do the job that we in the House are legislating for it to do on behalf of patients.

At a national level first, I say to the Secretary of State as his junior Minister is not present that setting up HealthWatch England as a sub-committee of the Care Quality Commission just does not cut it. It is implausible that a body can act impartially and fearlessly on behalf of patients if it is a sub-committee of the care regulator. How can it be, and equally important, how can it appear to be independent and authoritative, if it is set up within the administrative, organisational and financial embrace of the CQC? The CQC itself is clearly one of those organisations that HealthWatch England and local healthwatch bodies may need to stand up to and criticise.

There was an amendment in the other place to give the Government an opportunity to change their mind and set up HealthWatch England as an independent statutory body. That Labour-led, Labour-moved amendment was defeated in the other place, I am sad to say, by a combination of Conservative and Liberal Democrat peers.

Secondly, on the local healthwatch organisations, I think I understood what the Minister said earlier—that the Bill introduces a statutory duty on local authorities to set up a local healthwatch organisation. Placing a statutory duty on a local authority to carry out a particular activity is very different from creating a statutory basis for that organisation to operate in its own right. How will that arrangement at local level ensure independence, representativeness, good local links and resources—the four things that I would argue are the essential elements of an effective organisation on behalf of patients? On the fourth point, which is about resources, I may have missed something in today’s debate or in the debate at the other end of the building, but we still have not had clear answers to the following questions. I would be grateful if the Minister answered these questions when he deigns to return to the Chamber to respond to the debate, unless the Secretary of State will be doing that himself.

First, will local healthwatch organisations be funded directly by the Department of Health? Secondly, if funding will go via local authorities, what will the mechanism be for that funding? Thirdly, will funding for local healthwatch organisations be consistent across local areas so that patients, wherever they live, can be confident that they have a strong local representative organisation working on their behalf? Otherwise, this is legislation for a local lottery in patient representation and the strength of local patient voices.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I congratulate my right hon. Friend on the many excellent points he is making. Is it his understanding, as it is mine, that all the local healthwatch activities could be carried out by private sector—and therefore, for-profit—bodies? Does he feel that providing the strong, independent, representative voice for local people should be a profitable activity for private sector organisations?

[John Healey]

My answer to my hon. Friend’s second question is no, and I do not know the answer to her first question, which should really be directed to the Minister. We need an explanation of how the system for setting up, or in effect franchising, local patient organisations will be carried out, what sort of framework that will take place in, and what standards, if any, will be required for the way they are set up and run.

[Fiona O’Donnell (East Lothian) (Lab)]

Does my right hon. Friend not find it incredible that after a pause, two Bill Committees and all the debates in this place and the other place, we still do not have answers on a matter that is so important to patients?

[John Healey]

I find it dismaying, because there are so many people who are committed to the health service, work in the health service or are dependent on the health service, as we all are, and they want answers to that question, but the Government are simply not giving them. To be honest, I think that this stems from the genesis of the legislation, something that was ruled out explicitly in the Conservative party manifesto and the coalition agreement but then sprung in a White Paper less than two months after the general election. That meant that the civil service, the health profession and the NHS were unprepared for this huge reorganisation and this huge Bill, so in many respects, beyond the main decisions set out in the White Paper in July 2010, all the evidence indicates that the Government are making it up as they go along. The fact that we have seen more than 1,000 amendments to the Bill since it was first introduced is a further indication of that.

Is the Minister coming back?

[Nic Dakin (Scunthorpe) (Lab)]

My right hon. Friend is making a very decisive set of points. I would like briefly to draw his attention to the local patient healthwatch group in north Lincolnshire, Who Cares, which has produced some hard-hitting reports on matters such as mental health and discharge from hospital. Does he feel that arrangements are being put in place that will allow that sort of independence of view and those hard-hitting reports that help to improve the quality of care in future?

[John Healey]

My hon. Friend hits right at the heart of the flaws in the arrangements proposed tonight, which I was going to move on to. I am sure that Who Cares has its ear to the ground, good local connections and strong representation, and I want to see that continue, as I am sure he does. The real question is whether those organisations can go beyond hard-hitting reports, and who then will be accountable for the action that might need to be taken to follow them up. Where are the enforcement powers that could ensure that any problems they identify on behalf of patients are properly dealt with? I will move on to that point in a moment.

In a sense, that links to the point I wish to put to Ministers now. In the arrangements before us it seems that if a local healthwatch organisation is not up to standard, is not doing the job and is somehow failing patients in an area or falling short of what is expected, we will be offered a new provision, a new power introduced by the Government through an amendment in the other place, for HealthWatch England to write a letter to the local authority, telling it that it must do better. Thinking of the two local authority leaders in the area that I am privileged to represent—Steve Houghton, the leader of Barnsley metropolitan borough council, and Roger Stone, the leader of Rotherham metropolitan borough council—I could not use language in this House that is likely to reflect their reaction. If I think of them, as elected local government leaders, receiving a letter from a sub-committee of a national quango responsible for regulating things that their local authorities have little or no responsibility for, telling them that they are not doing their job properly, I can just imagine their reaction. Quite frankly, “You’re having a laugh.” That is simply not a serious power of, or provision for, redress on behalf of patients when a local patients’ representative organisation is failing to do the job properly. So, no enforcement powers and no intervention powers, only the power to write a letter to the local authority.

In the end, that brings us to the point. At this stage, in the final hour, at the end of this extraordinary Bill’s passage through Parliament, we can see very clearly the truths at the heart of it. There is provision for an independent national commissioning board, an independent market regulator and independent hospital foundation trusts, but there is no provision for an independent patients’ organisation.

In this Bill there are powers to ensure strong action to guarantee competition, strong action to guarantee financial efficiency and strong action to guarantee professional concerns, but there are no powers to guarantee any sort of action, let alone strong action, on behalf of patients.

I listened very carefully to my hon. Friend the Member for Leicester West (Liz Kendall), who made a very good speech from our Front Bench. When she notes that the representative body, National Voices, says on behalf of patients and interests groups, “You’re setting us up to fail,” and reads the letter from Malcolm Alexander, the chair of the National Association of LINks Members, who says, “You’re creating weak bodies that will not be independent,” I think that we in this House should be worried. Such action is, to borrow a phrase, pennywise, pound foolish. The Government are cutting what to Ministers and civil servants might seem to be small corners, but there could be big consequences for patients.

I see a link—a common characteristic—between this debate and our earlier debate on the risk register. The Government will live to regret at length poor judgments and decisions made in haste and under pressure now. The Secretary of State will face the question of whether to release the transition risk register. If he insists on remaining resolute in refusing to disclose, and if he insists on keeping it secret, patients will ask, “What are they hiding from us?” In the future, in the months ahead, long after the Bill has received Royal Assent and is on the statute book, patients will rightly ask when things go wrong, “Did they know these risks were there, and why didn’t they tell us?”

The same applies to HealthWatch. When things go wrong, patients will find that they do not have the recourse and the representation that they may need to act and intervene on their behalf, and they may well find that the arrangements that we are invited to pass tonight are too weak to help them. I say to the Health Secretary, who is now on his own on the Front Bench, that this is likely to reinforce that lack of confidence and lack of trust in the notion that the Government’s huge upheaval in our NHS, and this huge piece of legislation before the House, really is in the best interests of the NHS and NHS patients.

[Liz Kendall]

On a point of order, Mr Deputy Speaker. Is it in order for the Minister who moved these particularly important amendments, which will abolish a statutory organisation, HealthWatch, to be absent from the debate? If it is in order, is it not a huge discourtesy to Members on both sides of the House?