Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 21st February 2012 Commons Chamber

[Paul Burstow]

My hon. Friend, who chairs the all-party group on cancer, has been pursuing that issue vigorously. We certainly need to ensure that we use both proxy and other performance indicators on cancer outcomes, and I will want to continue examining whether that indicator is the most appropriate one to tell us what we need to know about improvements in cancer outcomes performance.

[Liz Kendall (Leicester West) (Lab)]

The hon. Member for Basildon and Billericay (Mr Baron) is right that early diagnosis is crucial for treating cancer, and it is often very worrying for people to wait for their test results. Under the current Government, waiting times for diagnostic tests have soared. Will the Minister confirm that the number of patients waiting more than six weeks for their test has more than doubled since May 2010, the number waiting more than 13 weeks has more than trebled and the average wait is up, too, by 28%? It is a simple question, so will he give us a simple answer—yes or no?

[Paul Burstow]

It was a somewhat longer question than that, so I hope the hon. Lady will let me go a little further than a yes or no. I tell her that at the end of December 2011 only 1.4% of patients were waiting six weeks or longer for one of the 15 key diagnostic tests, and that just five NHS trusts are responsible for about 30% of all waits of six weeks or longer. We are working specifically with those five trusts to bear down on those waits and ensure that people do not have to wait so long. Of course she is right to make her point about waits, which is why the Government are focused on the issue and have sent in the additional support needed to ensure that trusts deal with it.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 10th January 2012 Commons Chamber

[Anne Milton]

My hon. Friend is right; we picked up a very depleted and demoralised health visitor work force. We have 26 health visitor early-implement sites and, as I said, a 200% increase in planned training commissions for health visitors. Turning this round takes a long time. I am sorry that we could not get started on it earlier, but this will have the critical impact: 4,200 health visitors by the end of this Parliament will give us the results that we need in turning round the fortunes of some of the most vulnerable families in this country.

[Liz Kendall (Leicester West) (Lab)]

Early intervention can transform health for children and young people and prevent bigger and more expensive problems down the line, yet the Government have cut funding for early intervention programmes, including Sure Start, teenage pregnancy and mental health in schools, by 11% this year and 7.5% next year. Is not the reality that it is this Government who are depleting and demoralising the health visitor work force, and that their short-sighted, short-term policies will make it harder to prevent poor health and cost us all more in the long run?

[Anne Milton]

The reality is that the Government are picking up a very depleted health visitor work force. School nurses, health visitors and the family nurse partnership are all critical. We picked up a very sorry state of affairs. The hon. Lady is right; early intervention matters, which is why we are doing it. I am just sorry that the previous Government did not take the action that was needed.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I entirely understand my hon. Friend’s point. I of course will not prejudice whatever might be said in relation to that, but I will look at the report very carefully when it is presented.

[Liz Kendall (Leicester West) (Lab)]

Social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government are cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year. The Minister responsible for care said in Westminster Hall on 10 November:

“cuts to front-line adult social care services are really beginning to bite.”—[Official Report, 10 November 2011; Vol. 535, c. 178WH.]

Does the Secretary of State agree?

[Mr Lansley]

I have to say to the hon. Lady that it was this Government who, through the spending review, gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by my right hon. Friend the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, I have announced our Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.

Hinchingbrooke Hospital

Liz Kendall Excerpts

Thursday 10th November 2011 Commons Chamber

[Liz Kendall (Leicester West) (Lab) (Urgent Question)]

To ask the Minister of State to make a statement on the decision to allow Circle to run Hinchingbrooke hospital.

[The Minister of State, Department of Health (Mr Simon Burns)]

Today, a 10-year contract was signed by Hinchingbrooke Health Care NHS Trust and Circle allowing Circle to take over management of the trust, which has struggled to be financially viable in recent years. Major service problems have persisted and, despite repeated attempts to tackle it, the trust now has the largest legacy debt as a proportion of turnover in the NHS: £39 million, which amounts to almost half the hospital’s £100 million turnover. Moreover, the Care Quality Commission has expressed concern about the fact that its stroke services are failing and its cancer services under-achieving. The local NHS accepted that major changes were needed, and early in 2007, when the previous Government were in power, established the Hinchingbrooke next steps project to identify options for securing the trust's future.

In 2008, East of England strategy health authority chose a franchise model, and in 2009 it launched a competitive procurement process to identify a preferred bidder. That was agreed with the previous Government, and the power to bring in another person or organisation to manage an NHS hospital was introduced under that Government’s National Health Service Acts 2001 and 2006 and the Health and Social Care Act 2001.

At the end of last year, following a rigorous and open competition that included NHS organisations, NHS East of England announced that Circle had the most viable plans to turn the trust around. That decision has been endorsed by the Department of Health and the Treasury following an equally rigorous approval process this year. It should be noted that it was the Labour Government who set up the initial competition, a process from which many NHS organisations dropped out, leaving only private providers in the competitive tendering frame.

Circle is an established provider of services for NHS patients, although it should be emphasised that under this contract NHS services will continue to be provided by NHS staff, from NHS buildings, and that patients will continue to have access to them as they do now. No NHS staff are leaving, and assets will remain in public ownership. Hinchingbrooke hospital will continue to deliver the same NHS services, as long as commissioners continue to purchase them, adhering to the key NHS principle of care being free at the point of use. This is not a privatisation in any shape or form. Circle will help clinicians and health care professionals improve Hinchingbrooke from the bottom up. Its plans include improvement in length of stay, rationalisation of theatre usage and improvement in back offices. Commissioning leaders, hospital consultants and Royal College of Nursing representatives in Huntingdon clearly support Circle commencing the franchise. Tony Durcan, the RCN professional officer for Cambridgeshire said:

“Circle are very impressive…I welcome working with them.”

He went on to say that he believes the decision to work with Circle

“does secure the long-term future of Hinchingbrooke.”

If Circle achieves its forecasts, the whole of the trust’s accumulated deficit will be repaid by the end of the 10-year contract. Circle is paid from the trust’s surpluses, so if there are no surpluses Circle does not receive a fee. Furthermore, if the trust makes a deficit under Circle’s watch, Circle must fund the first £5 million. At deficits above that, the trust can terminate the contract, so Circle really must perform well.

The Government believe this is a good deal for patients and staff at Hinchingbrooke. It is a new management model being tried in the NHS for the first time, but the trust has had huge problems over the past decade, and it now has an opportunity to turn its fortunes round. The local NHS even stated that without this deal Hinchingbrooke hospital’s future would have been in doubt.

The local NHS will maintain close scrutiny of the contract. The Appointments Commission has appointed a chair and two non-executive director-designates to form a new Hinchingbrooke trust board from February 2012 that will appoint a franchise manager. The franchise manager will be responsible for day-to-day monitoring of contract performance. During the initial mobilisation stages, NHS Midlands and East will continue to oversee the franchise agreement.

Patients and the public deserve, and must get, a safe and sustainable NHS based on its core, historical principles. This contract will deliver that.

[Liz Kendall]

Patients, the public and NHS staff will be concerned about the implications of this unprecedented agreement not only locally in Cambridgeshire, but for the NHS across the country. Let me be clear that Opposition Members accept that there have been problems with this hospital for some time. My right hon. Friend the Member for Leigh (Andy Burnham)—who is currently visiting St James’s university hospital in Leeds—will set out the background to this issue and how it was dealt with by the previous Government in a statement later this morning, but it is the current Government who have made the decision to transfer the management of Hinchingbrooke to the private sector, and it is the current Government who must account for their actions.

First, I want to deal with the practicalities of the agreement. How many bids to take over the running of the hospital did the Government receive, and what criteria were used to judge them? Circle’s chief executive confirmed on the “Today” programme this morning that Circle has no experience of running emergency and maternity services, so why was the company chosen? What confidence can patients and NHS staff have in the chief executive’s claim this morning that Circle will be able to pay off Hinchingbrooke’s £40 million debt simply by cutting waste and bureaucracy when all previous attempts have failed—at the same time as, apparently, providing patients with Michelin-star meals and delivering profits for Circle’s shareholders? Can the Minister assure the House that this agreement will not, in reality, lead to staff jobs being cut and services being closed, and can he give a firm guarantee that all services currently run at Hinchingbrooke, including accident and emergency and maternity, will remain open throughout the entire period of the deal? Will he also set out whether the agreement requires Circle to work with other local NHS services and the council, what profits are permitted under the agreement, and how decisions will be held to account locally under it? Will he also place a copy of the agreement contract in the Library of the House?

The Minister must also today answer serious questions about the implications of this agreement for the wider NHS. He must set out whether the Government envisage any limit to the role of the private sector in the NHS. We know that Department of Health officials have been discussing the takeover of 20 other hospitals by private companies, so will the Minister tell the House how many of these hospitals will be taken over by the private sector? What steps have the Government taken to ensure the financial stability of Circle and its parent company, Circle Holdings? What will be the implications if the company goes bust, as Southern Cross did, for patients and taxpayers?

Finally, important questions need to be answered about why this company has been chosen. Given its close links to the Conservative party, there needs to be full transparency about all meetings—formal and informal—between Department of Health and Treasury Ministers and this company and any of its paid advisers. So will the Minister agree to publish full details of these meetings so that patients and NHS staff can have full confidence that the Government followed proper due process in their decisions?

Patients and the public will be deeply worried that this morning they have seen this Government’s true vision for the future of our NHS with the wholesale transfer of the management of entire hospitals to the private sector. The Health and Social Care Bill currently before Parliament not only allows that to happen but actively encourages it. Patients and NHS staff do not want this and the public have not voted for it. It is time that the Government agreed to drop their reckless NHS Bill.

[Mr Burns]

I am rarely speechless, but I am left speechless by the sheer effrontery of the hon. Lady. I have to remind hon. Members that this process stems from the previous Labour Government’s legislation in 2001, which was consolidated in 2006. This process started in 2007 at strategic health authority level, when she was a special adviser in the Department of Health. It continued, and the decision to move forward from a Department of Health level was taken in 2009 by the then Secretary of State for Health, who is now the shadow Secretary of State. It is often thought that shadowing a Department that one ran is helpful because one knows where the bodies are buried. The problem for the shadow Secretary of State is that not only does he know where the bodies are buried, but he was the one who buried them in the first place.

The hon. Lady asks how many bidders there were. As she will appreciate, a number of processes have taken place. There were 11 bidders at the start, the vast majority of which were private sector bidders, although there were some NHS ones—this was in 2009, under a Labour Government. The number reduced to six in December 2009, again under a Labour Government. Of those six bids, one was from an NHS body and one was from an NHS body in conjunction with the private sector. In February 2010, when I believe the right hon. Member for Leigh (Andy Burnham) was the Secretary of State, the number reduced again, this time to five. All these bids were from the private sector, except one, which was made in conjunction with an NHS trust. In March 2010, again under a Labour Government, the number reduced to three, with one bid associated with an NHS body, and then it reduced to two, with both bidders in the private sector.

--- Later in debate ---

[Mr Burns]

I do not know who has been briefing the hon. Lady, but the lines are wrong, I am afraid. She is right that the final decision was taken by me, in this Administration, but—[Interruption]—if she will just wait a minute, I will tell her that all we were doing was following what the previous Government set in motion. I will tell her something else: if there were a Labour Government in power and not this Conservative Government, the Labour Minister of State would be standing here today and making exactly the same points—

[Liz Kendall]

You don’t know that.

[Mr Burns]

The hon. Lady says that I do not know that, but surely she accepts that Labour politicians are consistent and would consistently follow their own policy. I am sure that they would be here doing so.

Social Care Funding

Liz Kendall Excerpts

Thursday 10th November 2011 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone, and a pleasure to follow the thoughtful speech by the hon. Member for Meon Valley (George Hollingbery). I agree with many of the points that he made and I will come on to discuss them. I also thank the hon. Member for Truro and Falmouth (Sarah Newton) for securing this debate, and all other hon. Members who have spoken.

I will begin not with how we are going to fund the future system of social care, but with the “crisis in care” that older and disabled people, and their carers and families, are experiencing. Those are not my words but those of the Care and Support Alliance, which is an alliance of 52 major organisations representing older people, disabled people, their carers and families. It is important that we are clear about the state of the current system and the scale of the task we face. It will mean difficult decisions for all political parties.

I will begin with a point that has already been made by several hon. Members. Under the current system, there are substantial levels of unmet need. Although the Association of Directors of Adult Social Services is right to say that that need is difficult to quantify precisely, the King’s Fund has estimated that the unmet need gap in the current system is around £1.2 billion.

Those unmet needs are increasing. To a large extent, that is because of our ageing population. That is a good thing, but it means that more people are living to a very old age with one, two or perhaps three long-term, chronic conditions, such as dementia. We simply have not seen that in the past, and it is happening at a time when budgets for both the NHS and social care are being squeezed and they are not changing sufficiently fast to meet the changing needs of our population.

However, unmet need is also growing, because councils are tightening and restricting their eligibility criteria for services. Eight out of 10 councils now provide services only for people with substantial or critical needs, and as my hon. Friend the Member for Lewisham East (Heidi Alexander) said, those are people with very real and serious care needs, not simple needs. “Substantial” means very serious needs.

Mencap says that 83% of councils are meeting only substantial or critical needs for adults with learning disabilities. That is up from 73% only one year ago. Nine out of 10 councils have increased their charges for both residential and domiciliary care. Many councils are restricting the time allowed for home visits. Help At Home, one of the biggest home help providers in Leicestershire, told me at my surgery last Friday that Leicestershire county council is paying for blocks of 15 minutes of care, down from 30 minutes previously. It told me that if the carers go just over that, the council rounds down the time for which it will pay. That is causing huge problems, first and foremost for older people. In many cases, it is simply impossible to get an older person up, washed, dressed and fed in such a short time. It is also causing a problem for staff who, once unpaid travel times are taken into account, are not even earning the equivalent of the minimum wage in the course of a working week. As a result, Help At Home is losing staff and finding it very difficult to recruit new staff, which the organisation simply has not experienced before.

It is clear that one of the fundamental reasons for tightened eligibility criteria, increased charges, and reductions not only in preventive services but in services such as day care centres is the cuts to local council budgets. The Government say that they are providing £2 billion of additional funding for social care in the course of the spending review period. The Association of Directors of Adult Social Services says that the reality is that social care spending has been cut by £1 billion this year, with even bigger cuts likely next year. Analysis by the House of Commons Library shows that, according to Department for Communities and Local Government figures, there will be a real-terms cut of £1.34 billion to adult social care in the Government’s first two years once inflation is taken into account; £1.3 billion is being cut from social care spending for those over 65.

The figures are based on the assumption that councils receive every single penny of the money that the Government say is being transferred from the NHS to local councils. In many cases, that is happening, but I have been told by several leads for adult social care that they are not getting all the money, and that that applies particularly to money for carers. The reality is that local council budgets are being cut by 27% during the spending review period and that that will have an effect on adult social care, because social care budgets are the biggest discretionary spend for local councils.

The Government say that there is no reason why local councils should end up cutting social care services because of the cuts in council budgets. I just point out that the Government have readily said that councils need extra money to pay for weekly bin collections. I ask hon. Members to reflect on that sense of priorities.

The consequences of the decisions are being felt by older and disabled people, who, as my hon. Friend the Member for Lewisham East also said, have been denied the up-front preventive services and support that could keep them healthy and independent in their own home. Older people, whether that is the old old or people aged 65, like my father, do not want to be reliant on any kind of help. They want to be independent. Our goal is not to be dependent on any kind of help from the state, but to live independently for as long as possible. However, the help and support that people could receive to achieve that independence is not happening. The consequences of the cuts and decisions are being felt by families and carers. Many hon. Members have talked about the pressures on carers, many of whom are at their wits’ end struggling to make ends meet, at grave risk to their own physical and mental health.

Something that has not been mentioned in the debate is the fact that the consequences are also being felt by businesses and the wider economy, as companies lose the skills and experience of carers who are forced out of the labour market because there is not enough affordable, good-quality and flexible social care to allow them to stay in their job. That problem will only get worse as people are required to work longer before they retire, and care longer at the same time.

The consequences are also being felt by taxpayers, as older and disabled people end up using more expensive hospital services when they do not need to. Several hon. Members have rightly said that delayed discharges from hospitals are up by 11% in the latest month for which data are available compared with the same time last year. That is because we are not getting the right system in place, which costs us all more in the long run.

I want to be clear: I firmly believe that we can make far better use of existing resources if we genuinely bring together health, social care services and other services such as housing and shift the focus not only more towards prevention, but much more towards a personalised service. I am grateful that the hon. Member for Meon Valley talked about the Total Place work under the previous Government. We must begin to see all these local budgets as one pot of money that can be used.

Hon. Members will have many good examples from their constituencies of ways in which preventive services have saved money. One example from the time of the previous Government is the partnerships for older people projects, which brought together health and social care around individuals’ needs. Overnight hospital stays for people in the projects were reduced by 47%; accident and emergency attendance was reduced by 29%; and once all the other services such as occupational therapy and physiotherapy were taken into account, £2,166 less per person was spent, so there is huge potential.

Even if we get those big shifts in the way in which services are run, more funding will be needed for the system in future. That is why the Labour party has offered cross-party talks on the proposals set out by the Dilnot commission. As hon. Members have said, there is widespread, although not total, consensus in favour of the commission’s proposals. We are serious about engaging in meaningful talks on the Dilnot proposals as a step towards a better system in future. We have set aside our experiences before the last general election, when very unhelpful comments were made, which wasted an opportunity for cross-party consensus.

If talks are to be serious, meaningful and successful, four key things need to happen. We have written to the Secretary of State setting them out, and I will outline them now. First, all relevant Departments must be engaged in the process. Securing agreement on the funding and implementation of the Dilnot proposals goes far beyond the remit of the Department of Health and the Health Secretary. The engagement of the Treasury is particularly important in the process.

Secondly, we have suggested that there should be an independent chair for cross-party talks, as we believe that that would make a successful outcome more likely. Thirdly, we think that an agreement is far more likely to be reached if there is transparent access for all parties to policy advice and information. We have suggested having an independent secretariat to provide equal access to the negotiating teams as required. Finally, we have requested that the leaders of the three main parties meet to agree a clear timetable for talks, with a view to securing a successful outcome and a joint statement before the publication of the White Paper next spring.

I think that many organisations representing users of social care and carers would agree that such steps are vital. If we are serious about cross-party talks to get all parties to sign up to big future public spending commitments, the talks need to be serious, and they need to have a serious process. I need not say this: such an agreement will be extremely difficult and challenging to reach in our antagonistic and combative political environment.

[Kelvin Hopkins]

I am listening with interest to my hon. Friend, but I am slightly concerned that there might be—if one likes—a conspiracy between the Front Benchers of the different parties to keep down expenditure rather than do what is needed. It might mean the Labour party saying, “We are going to have to spend more,” and raising the revenue to pay for it.

[Liz Kendall]

I am under no illusion about the scale of the funding challenge to meet the needs of our ageing population. Funding the current, unfair and ineffective system of social care will cost £12 billion by 2025. The Dilnot proposals, on top of that, cost more than £3.5 billion. Dilnot is an important step that we want to have genuine talks about, but it will not solve the entire problem that we face about the future of social care. Yes, we can make a big difference by looking at how we join up health, social care, housing and other spending, but there are clear implications for all parties in taking the matter forward, and we all need to be aware of them.

[Barbara Keeley]

My hon. Friend is making a good argument, and I am heartened by what she is saying. However, if the implications that she has just helpfully outlined exist, the debate has to be taken out to people. If there are implications for taxpayers, they have to know what they are. Many Members who have spoken today have said that it is quite clear that people do not understand or plan for care, and then the costs hit them. The debate out there, in addition to the essential cross-party talks, is important.

--- Later in debate ---

[Liz Kendall]

I could not agree more. The deal must not be done behind closed doors. There has to be a discussion between political parties, but most importantly, there has to be a discussion with the public—not just the current users of the system and their carers, but people who are not in the care system and younger people, who are working now and who will have to understand the issue. We have to have a full and proper debate.

[John Pugh]

During the previous general election, we all had a number of hustings meetings. Whenever the topic cropped up, a theme that came across forcibly from all members of the public was that they wanted the parties to discuss the issue together and that they were rather saddened by what happened immediately before the election.

[Liz Kendall]

I was not a Member of Parliament then, but from my own experience in hustings, I think that people feel let down when such an important issue becomes a political football. The hon. Member for North Norfolk (Norman Lamb), who was the health spokesperson for the Liberal Democrat party at the time, did not engage in that kind of behaviour. I do not want to go over old ground.

We need to discuss the matter, but it will be difficult. We all know what politics is like, and how parties use things to get at the other side. The issue will not be easy—it is about public spending and implications for individuals. What will they and taxpayers have to pay? We would be kidding ourselves if we thought that the issue would be an easy one.

I agree with all hon. Members who have said that the issue is one of the biggest challenges that we face, even if that is a cliché. We all think about it for our constituents and in our own families. I think about it, as many other hon. Members do, for myself, as I hope to live to a ripe old age. It will be a difficult challenge, but I hope that today’s debate shows that we are at least prepared to engage with the difficult issues to take the debate forward.

NHS Care of Older People

Liz Kendall Excerpts

Thursday 27th October 2011 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I thank the Backbench Business Committee for allowing us to have the debate. In particular, I thank the hon. Member for Stourbridge (Margot James) for securing it. I also want to thank all other hon. Members who have spoken and given passionate, heartfelt and thoughtful contributions.

Hon. Members from all parts of the Chamber have spoken with one voice. It is completely unacceptable for any older person to receive the appalling standard of care that we have read about in the CQC report and in the ombudsman’s report. We have seen that appalling standard of care in our own constituencies. My hon. Friend the Member for Bolton West (Julie Hilling) has seen it in her own family. Although we may not have seen as poor a standard of care as she did, I am sure that many of us have been concerned about the care given to our own families. I would like to consider some potential causes of those poor standards of care, and talk about possible measures to tackle them and to ensure that every service matches the best standards.

It is important to look closely and carefully at this question and to avoid thinking that one issue, one group of staff or one set of problems is to blame. While there are some straightforward, practical steps that could be taken immediately, there will not be one simple quick fix that will solve the whole issue. There are deeper and more complex issues that are far harder to address. I will talk about five areas: staff levels and resources; staff training, which many hon. Members have spoken about; culture and leadership; the regulation of the NHS; and deeper issues that are very difficult to address.

Several hon. Members, particularly at the beginning of the debate, raised the issue of staffing levels and resources. If we talk to individual members of staff or organisations such as the Royal College of Nursing, they say that the issue is of concern. Staff to patient ratios were referred to by the hon. Member for Stourbridge and the hon. Member for St Ives (Andrew George). Peter Carter, who runs the RCN, gave me a stark example. The figures are rough and not perfect, but he said that paediatric and children’s wards have one nurse for every four patients, while in the wards that specialise in care for older people the ratio is around one nurse for every 10 patients. Elderly, dependent patients have different needs from sick young children, but in many ways they are just as challenging, so we need to look at that, particularly because, with an ageing population and some of the problems in social care, more sick elderly patients are ending up in hospitals, many with not only dementia but two or three other health problems. That co-morbidity issue will be important as we see hospitals with big financial challenges, which we will over the next couple of years.

On staff training, we often hear commentators or senior people in the NHS, frequently medics, who question whether moving nursing towards being a degree profession has been an entirely good thing. It is vital to get the right balance between academic and practical elements in nurse training. Degree courses have been around for many years—40, I think. As many hon. Members have said, we see differences between and even within hospitals that are using nurses with the same qualifications, often from the same universities, and some have their problems and some do not. We need to look at the balance, but we should not think that that is the entire cause of the problem. A lot is down to the culture created in wards, which I will say more about in a moment.

Concerns have been expressed by many hon. Members today, the media and NHS staff about health care assistants. Health care assistants in wards provide more and more of the care, some of which is intimate, such as feeding older people or helping those with continence problems, but it is a positive development. As other hon. Members have said, our staff have the right values, and that is partly about the training they get. I think the hon. Member for Stourbridge said that health care assistants do not get any training and are not regulated, but they do, or should, get training from their employer, the trusts. Such training can be patchy, and we need to look at that.

In 2003, I called for the regulation of health care assistants—as many people did, way before me—in a project I did called “The Future Healthcare Worker.” If nurses are to take on some of the more clinical roles, and health care assistants more care, we need to look at that issue. I had hoped for more progress on that under the previous Government. It would be interesting to hear from the Minister the current Government’s views on regulation. There are all sorts of issues around time and cost—for employers and individual staff—but it is something we need to look at.

Culture and leadership are woolly words, but in practice we know when we see good culture and good leadership. My hon. Friend the Member for Wirral South (Alison McGovern) made this point. What is it on the ward that matters above all? Yes, it is about how long it takes to be treated, whether operations are a success or whether medicine is taken on time, but it is also, crucially, about the experience of the patient, whether they and their families feel that they have been given enough information and the time to think about it. When the information is given can be important. We have all been in situations where the doctor has said something quite shocking and we were not prepared for it. What matters is the simple things such as whether the patients are covered up when they go to the toilet and cleaned effectively afterwards.

There are places where the patient’s experience is at the top of the agenda, not only of the individual ward but of the hospital as a whole. Simple and straightforward surveys, developed by organisations such as the Picker Institute, can help individual organisations and services to get that across.

Another thing about culture is a bit more tricky and concerns how we build a team and being open to questioning. In a team, staff should value each other’s different experiences. That might not be the case with some of the old-fashioned hierarchies in a hospital—doctor, nurse, care assistant—where they do not dare question one another. Teams need to value each other’s skills and experiences but also be open to questioning.

[Alison McGovern]

One of the best examples of quality of care that I have seen recently was in one of my local hospitals, when I was shown around a ward in part by the cleaner, because she was deemed to be so important to the good functioning of that ward.

[Liz Kendall]

That is absolutely right. It is not that everyone has the same skills and experience, but that all those different skills and experience are important. In a proper culture of learning, mistakes can be admitted, because we all want to learn from them to ensure that they do not happen again. We need to see not only the different health professionals as part of the team, but users and families too. Peter Carter of the RCN raised the issue of families being involved, and it was sad that all over the papers he was reported as saying, “Come in and care—it is up to you to care for members of your own family.” What we need, though, is for families to be part of the process, particularly if their relatives are elderly patients suffering from dementia. Family members know them best. We might not be able to hear what they are saying but their family will know how they react, and whether they like or dislike something.

Such a culture and such leadership need to be in evidence not only on the ward, but on the board—a point made by the hon. Member for Stourbridge. As the boss, the board should want to know what is happening on the ward and its members should be getting the surveys and patient feedback. As with Members of Parliament, hopefully, what they will most want to know is what individual constituents think of them. Accountability is vital, from the top down. Also, in particular for old people who might not have family members nearby, the idea of volunteers who can be advocates and part of the process is important.

On regulation and the Care Quality Commission, I am concerned about the issue. More could be done immediately. The CQC has an important role to play, but I want to be clear that responsibility for the quality of services lies with the providers and not with the regulator. However, people want to have confidence that, if the CQC says that somewhere is okay, it is okay and, if it is not okay, that the CQC will go back and ensure that it is sorted out. I am concerned that, almost six months after the initial inspections, the CQC has not been back to a third of the hospitals it said in its report were failing to respect and involve older people, and it has not been back to two thirds of the hospitals that were failing to meet nutritional needs. I have written to the CQC, which has not written back, but it said on the phone that it had received written reassurances. That is not good enough. It should be going back to those hospitals. I am keen to hear from the Minister whether he could take action to ensure that we know which hospitals have not had a follow-up and what the timetable for action is.

There are clear national guidelines for people who work for public bodies such as the council or the NHS. There are guidelines on raising the alert and referring a person immediately—within one day—if it is thought that they are vulnerable or at risk of neglect or abuse. I have asked the CQC whether it referred people, or whether it required the hospitals to do that. If someone has seen children at risk of neglect or abuse, action would need to be taken or they could face the legal consequences. I am concerned about that matter.

I have spoken longer than I intended. I want to finish by addressing what I call “deeper issues”: our model of health care, the nature of medicine and the way we as a society treat older people. When our NHS was established, our population had very different health problems. People needed episodes of care for acute conditions that could be treated and increasingly cured. Our health services were based on the model of individual district general hospitals. However, we have health problems now that are related to people living longer with long-term and chronic conditions. Improving health is no longer solely about needing episodes of acute care that seek to cure people. It is about increasingly helping people to manage their long-term health problem, and, when they are very old or suffering from dementia, helping them to live to the end of their days as comfortably as possible.

Our model of health care has not kept pace with changing needs. One third of hospital admissions are for people over 65, but, because on average they stay in hospital twice as long, two thirds of hospital beds have an older person in them. Hospitals are not the place to care for older people, but hospitals are where we care for them. We must change that situation, which means shifting services out of hospitals and into the community. We need to focus more on prevention and joining up with social care.

There is a big challenge for medicine. We have talked a lot about nurses, but not about doctors’ mentality. They are trained to cure. There is a big challenge for doctors as well as nurses as our health needs change. In too many places, doctors are still at the top of the hierarchy. They are the ones who help to determine the shape of care. It is important to look at their changing role, too.

I want to talk about how we as a society treat older people. I hope we will have a proper debate about that one day. I want to say two things. First—I think other hon. Members have mentioned this—we are not used to seeing people get so old. It is quite a recent thing to see people living for such a long time, often in pain, and it is very painful for families, particularly if they see people whom they love suffering with dementia. Society shuts older people away too often. We say, “You’re just getting old” or we prefer that they are not seen and not heard. In other countries, it is not like that. Older people feel more part of the community and they are perhaps more visible than in this country. I can give a simple example. Care homes in Spain do not have opening hours—they are simply open—and people see them as part of the community.

The issue is about how our services cope with an ageing population and how we treat older people. If someone is very old and slowly dying, including from something such as dementia, which is awful to see, we need to find a new way to deal with that.

National Health Service

Liz Kendall Excerpts

Wednesday 26th October 2011 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to close the debate on the Government’s record on the NHS and to follow such excellent contributions from many hon. Members.

My hon. Friends the Members for Easington (Grahame M. Morris) and for Ealing North (Stephen Pound) rightly spoke of the waste of the Government’s NHS reorganisation. The Government have spent £850 million on redundancy payments for primary care trust staff who will be re-employed in commissioning organisations elsewhere. My hon. Friend the Member for West Lancashire (Rosie Cooper) rightly asked the Secretary of State, who is moving from his usual place on the Front Bench, why he was not aware that trusts are re-banding nurses in order to save costs. Labour Members, who talk and listen to front-line staff, know that only too well.

My right hon. Friend the Member for Rother Valley (Mr Barron) and my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), whom I was privileged to sit alongside in the Health and Social Care Bill Committee, rightly raised the risks of the Bill widening health inequalities and worsening patient care. My right hon. Friend was right when he said that the Bill will be one of the Government’s biggest mistakes.

The hon. Members for Stafford (Jeremy Lefroy) and for Central Suffolk and North Ipswich (Dr Poulter) rightly raised the important issue of the need to integrate health and social care and develop more community-based services, although Opposition Members believe that the Government’s NHS reorganisation, and their huge cuts to local council budgets and social care, will make that far harder, not easier, to achieve.

Before the general election, the Prime Minister made three key promises on the NHS. He promised no more top-down reorganisations; he promised patients up and down the country a bare-knuckle fight to save their local hospitals; and in both the Conservative manifesto and the coalition agreement, he promised that he would increase health spending in real terms in each year of the Parliament. Barely 18 months later, he is forcing through the biggest reorganisation in the history of the NHS—the NHS chief executive says that it is so large, it can be seen from outer space. Local NHS services in Bury, Burnley, Hartlepool and Chase Farm are not being saved or reopened as the Prime Minister and Secretary of State pledged, and, according to Treasury figures, spending on the NHS was cut by more than £750 million in real terms in the first year of this Government. That is three promises made and three promises broken by a Prime Minister who claimed that his personal priority was spelt out in three letters: NHS.

[Gareth Johnson]

Is the hon. Lady aware that in the past 40 years, real-terms spending on the NHS has been reduced on only five occasions, the majority of which were under a Labour Government?

[Liz Kendall]

I wish the hon. Gentleman had been here at the start of the debate, when it was made clear that the last real-terms cut in NHS spending was in the last year of the previous Conservative Government.

Doctors, nurses, patients and the public know the truth about this Government’s plans. When the NHS should be focused on meeting the biggest financial challenge of its life and on improving patient care, it has instead been plunged into chaos. At precisely the time that the NHS needs maximum leadership and financial grip, the Government’s reorganisation is creating havoc. First, they said that they would scrap primary care trusts and strategic health authorities, and replace them with GP consortia. Then they changed their mind, merging PCTs and SHAs in supposedly temporary clusters and replacing consortia with clinical commissioning groups and new clinical senates, and now they have changed their mind again: PCT and SHA clusters have apparently been saved as part of the Government’s huge new national quango, the NHS Commissioning Board, which will employ more than 3,000 people.

Professor Malcolm Grant, the Government’s own choice to run the NHS Commissioning Board, last week called the Government’s plans “completely unintelligible”. The very people who are supposed to be running the NHS are confused and wasting time trying to figure out ill-thought-through Government plans. That time and energy should be spent on patients. Far from cutting bureaucracy and saving taxpayers’ money, the Government are creating hundreds of new organisations and wasting more than £2.5 billion in the process, when this money should be spent on front-line patient care.

What has been the result of 18 months of a Conservative and Liberal Democrat Government running our NHS? Thousands of front-line clinical staff are losing their jobs and posts are being frozen, piling pressure on those who remain. [Interruption.] The Secretary of State shakes his head, but this month the Royal College of Nursing has surveyed 6,000 of its staff and made it clear that 20% of the nurses and health care assistants surveyed said that their job is going to be cut, that 40% are seeing recruitment freezes in their trust and that 13% are seeing bed and ward closures in their trust. Who is more likely to be accurate? The nurses and health care assistants working in our NHS, or the Government, who are denying that any of these changes are taking place?

The result is that patient care is going backwards. Far from what Ministers claim about waiting lists being fine, the number of patients waiting longer than four hours in A and E is now double that of last year. Twice as many patients are waiting more than six weeks for their diagnostic test, and six times as many are waiting longer than 13 weeks. Anybody who has waited, or has had a family member who has waited, more than three months even to get their test knows how worrying and frightening it is, yet the Government deny that there is a problem. Furthermore, 48% more patients are now waiting more than 18 weeks for their hospital treatment.

Despite all the evidence, the Government are in denial. They deny that the number of front-line NHS staff and the number of staff training places are being cut, yet a recent survey by the Royal College of Midwives has shown that six out of 10 SHAs have been freezing staff training places because of the cuts. Given that the Government promised 3,000 more midwives, that is a problem, particularly in constituencies such as mine that have increasing birth rates.

[Andrew Bridgen (North West Leicestershire) (Con)]

What is the hon. Lady’s opinion of the £12 billion wasted by the previous Labour Government on the failed NHS IT project?

[Liz Kendall]

The hon. Gentleman, who is a constituency neighbour of mine, would do better focusing his attention on the RCN and RCM in our area, which are asking us why the Government are not fulfilling their commitment on extra midwives. If he goes to the hospitals in Leicester, as his constituents do, he will know that there are concerns about that.

The Government deny that the number of front-line NHS staff is being cut, that waiting lists are rising and, worst of all, that there is still widespread and growing opposition to their NHS plans.

[John Pugh]

Does the hon. Lady seriously believe that the £20 billion-worth of savings required by the last Labour Budget could be achieved without cuts?

[Liz Kendall]

We have been clear on this side of the House. My right hon. Friend the Member for Leigh (Andy Burnham) took some difficult decisions when he was Secretary of State for Health, unlike the current Secretary of State. My right hon. Friend looked at what was happening in local hospitals and took the difficult decisions, based on clinical advice, to improve patient care. That is what this Government should be doing.

The Prime Minister says that

“the whole health profession is on board for what is now being done,”

but that is simply not the case. The RCN says that the Bill

“will have a seriously detrimental effect upon the NHS and the delivery of patient care”.

Four hundred of the country’s leading public health experts warn that the Government’s plans will cause “irreparable harm” and fail to deliver

“efficiency, quality, fairness or choice”.

The British Medical Association says that the Bill

“poses an unacceptably high risk to the NHS”.

Government Members now like to criticise the BMA, but before the general election they applauded everything the BMA said. They always want to have it both ways. Three quarters of GPs—the very people this Government claim they want to empower—have said through the Royal College of General Practitioners that the Bill should be withdrawn. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), says from a sedentary position that those groups—the RCN, public health experts, the BMA and the Royal College of General Practitioners—are self-selecting. That is the kind of dismissal of front-line staff that has caused such problems for the Government.

It is not just NHS staff whom the Government refuse to listen to. Organisations such as Age UK and Carers UK say that social care is in financial crisis too. The Government repeatedly claim that they have increased funding for social care, but eight out of 10 local councils are now restricting services to cover only those with substantial or critical needs. Two thirds say that they are closing care homes or day care centres too. The Government’s huge cuts to local council budgets mean that vital services and support for older people, their carers and their families are being eroded. That is not protecting the most vulnerable in our society, nor is it protecting taxpayers’ interests, because if we do not help older people to stay healthy and independent in their own homes, they end up in hospital.

In conclusion, when people think back to what the Prime Minister said before the election and the personal promises he made on the NHS, they now see the truth: a Government who are out of touch with what is really happening; a Government who refuse to listen to front-line staff; a Government in total denial about the true impact of their reckless NHS plans. This Government’s record on the NHS is one of promises cynically made and shamelessly being broken. I commend the motion to the House.

--- Later in debate ---

[Mr Burns]

No, I said that I would give way once. I must now make progress.

We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.

[Liz Kendall]

rose—

[Mr Barron]

rose—

--- Later in debate ---

[Mr Barron]

rose—

[Liz Kendall]

rose—

[Mr Burns]

The result is better care for patients and, for this group, a 80% fall in unplanned admissions, a 20% reduction in bed days and a halving of ambulance journeys. That means better care for patients and better value for the taxpayer.

[Liz Kendall]

Will the Minister give way?

[Mr Burns]

Just as Labour Members are wrong about NHS funding, they are also wrong about the Bill. [Interruption.] The Bill focuses on the most important thing for patients—the outcome of the treatment they need either to cure them or to stabilise their long-term conditions. Doctors, nurses and other health care professionals—[Interruption.]

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.

[Liz Kendall (Leicester West) (Lab)]

Many families will be deeply concerned about standards of care for older people in hospitals following the Care Quality Commission’s recent report. Patients and the public must be confident that all the necessary steps are being taken immediately to tackle this issue. Months after its initial inspections, will the Minister confirm that the CQC has revisited only six of the 17 hospitals that were failing to ensure that older people had enough food and drink, and if so, can he explain why?

[Mr Lansley]

Let me make it clear to the hon. Lady, whom I welcome to her new responsibilities, that the reason the Care Quality Commission undertook unannounced nurse-led inspections in hospitals to look at issues of dignity and nutrition was that I asked it to. As an independent regulator, it must make its own decisions about what it does, but I have been clear in my conversations with the Care Quality Commission that it is moving from the tick-box regulatory approach inherited from Labour to one focused on going out there and finding out where there is poor performance. The CQC is shining a light—not least at our request—on poor performance and poor care in the NHS, and it will continue to do so.

Health and Social Care Bill (Programme) (No. 3)

Liz Kendall Excerpts

Tuesday 6th September 2011 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

We oppose this programme motion because it fails to give hon. Members enough time to scrutinise one of the most important Bills of this Parliament and, indeed, of the 63 years of the NHS. It is one of the largest Bills of recent times and the largest ever in the history of the NHS, with 420 pages and more than 300 clauses. It is also one of the most controversial. It will force the NHS through a massive reorganisation, which is already happening even though the Bill has not been passed, when it should be focused on meeting the biggest financial challenge of its life and improving patient care. It also seeks to make fundamental changes to the way our NHS is run, driving competition into every part of the system whether or not it is in patients’ best interests.

Labour has led the arguments against the Bill since the autumn, helping to create the widespread opposition that has already forced the Government to pause and amend their plans. However, the Government, far from what the Minister said, refused to give the second Bill Committee enough time to scrutinise properly the changes after their so-called listening exercise. [Interruption.] The Minister tuts from a sedentary position, as is his wont, but 42 Government amendments and two new clauses were not debated in the second Committee due to a lack of time. They have not even bothered to publish the explanatory notes and impact assessment for the post-pause Bill, so the two days on Report that the programme motion proposes would have been insufficient in any case.

Then, on Thursday, three days before this debate, more than 1,000 new Government amendments were tabled, 363 of which are significant. They include a completely new set of proposals on whether local NHS services and, indeed, entire hospitals will be allowed to fail—proposals that could affect every constituency in England. It is a gross discourtesy to this House, not to mention to patients and NHS staff, to produce such important proposals and give such little time for scrutiny. I am sure that Members of the other place will take that into consideration in their deliberations on the Bill.

We are now faced with hundreds of significant new amendments and a series of fundamental questions about the post-pause Bill, and yet we have only two days for debate. Who will have the final say, and who is accountable for vital decisions about the future of local services? What will the Government’s health care market mean for expensive local services that do not make money, such as accident and emergency services and geriatric care, if hospitals lose services that do make money, such as hip and knee operations? How will NHS patients be protected if the private patient cap is abolished and hospitals are forced to take on more patients who pay in order to balance their books? What will be the true cost to taxpayers of the extra red tape and bureaucracy created by the Bill?

The Government’s failure to give the House sufficient time for scrutiny and provide proper answers about their Bill means that many NHS staff and patients remain deeply concerned. Unfortunately, that seems to have passed the Prime Minister by. Two weeks ago, he claimed:

“the whole…profession is on board for what is now being done.”

I wonder whether “the whole profession” includes the British Medical Association, which says—

[Mr Burns]

indicated dissent.

[Liz Kendall]

The Minister groans. If he thinks that the body representing doctors in this country is worthy of that response, that is a disgrace. The BMA says that the Bill is still

“an unacceptably high risk to the NHS, threatening its ability to operate effectively and equitably now and in the future”.

It calls for the Bill’s withdrawal

“or at the very least further, significant amendment”.

[Chris Skidmore (Kingswood) (Con)]

Is the BMA not the same organisation that opposed the creation of the NHS in 1948?

--- Later in debate ---

[Liz Kendall]

The Prime Minister claims that the whole profession is now on board for the Bill, and that simply is not the case. Government Members, particularly those on the Liberal Democrat Benches, should remember that the Government have no mandate from either the election or the coalition agreement for fundamental aspects of the Bill. In fact, the coalition agreement promises to do precisely the opposite—to stop top-down reorganisations of the NHS.

The Government want to railroad the Health and Social Care Bill through the House in the face of widespread opposition and huge controversy, and with no mandate for their plans.

[Andrew Percy (Brigg and Goole) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I will not, because we need to get on to the substance of the debate. The less time that the Government give MPs to scrutinise the Bill, the more people will think that they have something to hide; the more they hide, the longer it will take to get the Bill through the other place.

Unless hon. Members vote against the programme motion, it will be left to Members in the other place to provide the parliamentary scrutiny that the Bill needs and to get answers to the serious questions that remain. I believe that Members of this House should scrutinise legislation and get the answers to questions that our constituents need and deserve. The Government are refusing to give us the time to do our job. I urge Members to vote against the programme motion.

Health and Social Care (Re-committed) Bill

Liz Kendall Excerpts

Tuesday 6th September 2011 Commons Chamber

[Dr Poulter]

The right hon. Gentleman was a part of the party of Government at that time. Lord Warner was a leading member, and it is fair to point out that he has come forward with some good cross-party recommendations that we very much welcome. The recommendations point to the fact that the key challenge for the NHS is better integrating services and providing high-quality patient care, especially in elderly care and adult social care. That has not happened as effectively as it should have done in the last 10 years and we need to ensure that it does happen. That is why this Bill is a good thing.

Members on both sides of the House have generally welcomed the use of the private sector where it can add value to the NHS, especially for patients. That has to be a good thing, but we need to ensure—as the Bill does—that we do not have the cherry-picking that we saw in the past. We need to ensure that we have a health service that provides better value for money, better care and more integrated adult social care and health care for the frail elderly.

[Liz Kendall (Leicester West) (Lab)]

This is a crucial part of the debate that we will have over the next couple of days. Parts 3 and 4 of the Bill are at the heart of the Government’s proposals for the NHS and of the concerns that professional bodies, patient groups, members of the public and Members—at least on this side of the House—have about those proposals. These parts will introduce a new economic regulator for the NHS, modelled on the same lines as those for gas, electricity and railways. They also enshrine UK and EU competition law into primary legislation on the NHS for the first time.

We have also been discussing crucial new amendments that, despite what the Secretary of State says, have not been scrutinised by the Future Forum, about the Government’s new failure regime. That essentially addresses which local services and hospitals—such as we all have in our constituencies—will be allowed to fail.

Each of these subjects should be subject to separate and far longer debates, because they are of such importance to our constituents, our local NHS staff and our local services. However, because the House has been given so little time and the Government have tabled so many amendments, we have been forced to take these huge issues together—[Interruption.] As always, the Minister of State groans from a sedentary position, but Members have a right to question the Government on their proposals for local hospitals and services, and three or four hours is not sufficient. I hope that the other place will take that into account.

The Bill establishes Monitor as an economic regulator, modelled on the same lines as those for gas, electricity and railways. The explanatory notes make this explicit. Page 85 states that clauses in part 3 are based

“upon precedents from the utilities, rail and telecoms industries”.

Indeed, in an interview with The Times earlier this year, David Bennett, the new chairman of Monitor, confirmed that that was the Government’s plan, saying that Monitor’s role would be comparable with the regulators of the gas, electricity and telecoms markets.

Labour Members have consistently argued that such a model is entirely wrong for our NHS. People’s need for health care is not the same as their need for gas, water or telecoms. There is a fundamental difference between needs, ability to benefit, the complexity of services and the fact that they are far more interlinked. The NHS is not a normal market. It is not like a supermarket, or like gas or the railways. There are much more important issues at stake.

The Government have made some minor amendments to Monitor’s duties, but they will not ensure the integration and collaboration that many hon. Members recognise is vital to improving health, especially for patients with long-term and chronic conditions. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said, the duties still rig Monitor in favour of competition. It is not only Monitor’s duties that do that. Chapter 2 of part 3 contains 12 clauses that explicitly introduce competition law into primary legislation on the NHS for the first time. The clauses give Monitor sweeping powers to conduct investigations into NHS services; to disqualify senior staff in hospitals and other NHS services; and to impose penalties for breaches of competition law, including the power to fine services that are found to have broken the law up to 10% of their turnover. Not only that, but third parties, including competitors, can bring damage claims against those services.

The Government claim, as the Secretary of State did earlier, that somehow those provisions will not change anything. In that case, why bother to have the clauses in the Bill? As the hon. Member for Southport (John Pugh) said, Labour Members have argued not that the Bill extends the scope of competition law, but that it extends the applicability of competition law to the NHS. It is not just the clauses on Monitor and competition law that do this, but others such as those that abolish the private patient cap on foundation trusts, and other Government policies, such as that of “any qualified provider”.

[Andrew George]

I hope that the hon. Lady shares my disappointment that, despite the fact that we have debated this issue for four hours and that I have tabled nine selected amendments, I have not had the opportunity to explain the purpose of those amendments—even though the Secretary of State referred to them in his opening remarks. Does she accept, for example, that amendment 1207 relates to clause 58(3) and balancing competition versus anti-competitive behaviour? The other amendments seek to give integration a greater priority for the regulator to enforce.

[Liz Kendall]

I understand why the hon. Gentleman tabled those amendments and I understand his concerns. Opposition Members have consistently argued that the Bill threatens to pit doctor against doctor and service against service when they should be working together in the best interests of patients. Our view is that a far better approach than seeking to amend the Bill would be to delete part 3, because it is a fundamentally wrong way to treat our NHS. A few small changes to Monitor’s duties would not alter what the Bill seeks to do, and that is why amendment 10 proposes deletion of part 3.

The Bill will guarantee that the NHS will be treated as a full market, and the providers of services will, for the first time, be treated as undertakings for the purpose of competition law. The Secretary of State said that the Bill would not increase the applicability of competition law, but the Minister of State confirmed it when he told the Committee:

“UK and EU competition laws will increasingly become applicable…in a future where the majority of providers are likely to be classed as undertakings for the purposes of EU competition law, that law…will apply.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

If the Government wish to claim that that would not be the effect of the Bill, they should publish any legal advice they have taken. Again, we have two different stories. The Minister of State says that the Government have taken legal advice, but in answers to parliamentary questions we hear that the Government have not taken legal advice. Members deserve to know what the advice is about the implications of this Bill.

NHS staff, patient groups and members of the public have very real fears about the consequences of the Government’s proposals and the full market that is envisaged in the Bill. The previous Government saw that giving patients more choice and a greater say in their treatment, and bringing different providers into the system—including from the private and voluntary sectors—can bring real benefits, including improving outcomes and efficiency, especially in elective care. But we always did that using clear national standards that this Government are abolishing and with the ability to manage the consequences that choice and competition bring.

--- Later in debate ---

[John Pugh]

Is there not a big difference between making fundamental decisions, as we accept Monitor will sometimes have to do, and what the hon. Lady has just described, which is about taking the lead in the integration and sourcing out of services, which presumably is what the commissioners do? If she has read the other bits of the Bill, as I am sure she has thoroughly, she will be aware that the commissioners have a pivotal role in determining the shape, structure and character of local services.

[Liz Kendall]

I should add that, as the hon. Gentleman will see, page 6 of the briefing notes that the Government published on the Bill says that clause 104 would

“give Monitor discretion in determining where it is appropriate to include standard licence conditions for the purposes of securing continuity of services”.

As the NHS Confederation asks, how will Monitor have the local information and intelligence to make such complex judgments? How should patients and the public be involved? Monitor then has to keep the level of risk of the service under review, as well as taking decisions about whether and how to set differential prices for providers, to ensure the continuity of the process. How it is supposed to do that and how Members of this House, patients, the public or local councils are meant to hold it to account for that process is far from clear.

My biggest concern about the proposals is that they leave Monitor to intervene proactively to prevent services from reaching the point of failure. None of us wants such an outcome, but it is completely unclear when or how Monitor would do that. Page 10 of the technical annexe to the proposals said that the Government would

“expect Monitor to establish transparent and objective tests to determine when intervention is necessary and what level of support a provider would require”,

and claims that

“This would provide certainty to patients and providers”.

However, we have seen none of those details, and nor do we have any way of changing or influencing what Monitor does about the process, which is a real issue for hon. Members. Even under this Government’s flawed approach, it is astonishing that they say that they would only “expect” Monitor to publish criteria for early intervention. Why is that not in the legislation? Why is Monitor not required to publish and widely consult?

I want briefly to set out a couple of other concerns about the process. If it ends up not being possible to prevent a service from failing, what happens next? A trust special administrator will be appointed to take control of the hospital and report to Monitor and then to the Secretary of State. However, there is nothing in the legislation to say that local clinicians, let alone locally elected representatives, have to agree or sign off such proposals. Indeed, page 15 of the technical annexe says that “where possible”, the trust special administrator should

“secure agreement from clinical senates and clinical advisers”.

The idea is that clinicians would not be required to sign off the decision—the trust special administrator might also consult the health and wellbeing board, for example—about which I know many Government and Opposition Members have been concerned. There is nothing in the proposals to say that Monitor has to look at the impact of decisions in one part of a hospital or service on either the rest of the hospital or the wider health community. With the abolition of strategic health authorities, which take that regional view, that becomes a real concern.

The reason these proposals are so important is that there is a risk that there will be more failing services in future, and not only because of the financial squeeze that the NHS is facing—many hon. Members have talked about the real issue out there, which is that services are struggling to keep going, experiencing problems in balancing books and keeping on NHS staff—but as a direct result of Government policy to drive a full market into every part of the service, albeit without any ability to manage the consequences. In fact, the Government’s own documents make it clear that that is the point of competition. Paragraph B112 of the explanatory notes to the Bill states:

“For competition to work effectively, less effective providers must be able to…exit the market entirely”.

The Secretary of State likes to try to explain his way out of this system, but he cannot have it both ways. Either he wants that—for services to fail and new providers to be brought into the system—or he does not.