Oral Answers to Questions

Mark Reckless Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

Monitor has done extensive work on this issue, but my hon. Friend is absolutely right to talk about it. If we are to meet the financial challenge that the NHS faces over the next five years, we need to have a very sensible discussion about what realistic efficiency gains need to be made, and I am sure that he will engage in those discussions.

[Mark Reckless (Rochester and Strood) (UKIP)]

Medway clinical commissioning group is looking at putting GPs at the front of our accident and emergency department to help relieve pressures on emergency doctors. Do Ministers believe that that is a promising way forward?

[Dr Poulter]

There is certainly a lot of benefit from having general practice co-located alongside A and E so that people with more minor ailments or concerns can be seen by GPs. That can often take the pressure off A and E services, but more senior expertise is also on hand when required.

GP Services

Mark Reckless Excerpts

Thursday 5th February 2015 Commons Chamber

[Mark Reckless (Rochester and Strood) (UKIP)]

I thought that GPs had it rather good after their new 2004 contract. They were able to give up out-of-hours care on attractive terms, they saw their pay go up, and there was a system of quality and outcomes framework points which saw many GPs and practices move towards the maximum numbers quite quickly in what seemed to be more of a box-ticking exercise than had been anticipated, and for which there was further income.

However, the more I have looked at this and the more I have spoken to GPs in recent years, the more sympathetic I have become in relation to the pressures under which they operate. There clearly has been a great increase in demand for GP services. There is not agreement on the causes of that or on the importance of various factors, but several factors clearly have played a part. One of them is our population rising by close to 4 million in a decade. A significant part of that is due to immigration, and some is due to natural increase. The population is also ageing, which drives greater demand.

I am also concerned about the change from NHS Direct to the 111 service. I do not pretend to be an expert on this and to be able to give a definitive view, but there is at least some evidence to suggest that the 111 service with untrained staff, or at least not qualified nurses, taking calls has a significantly greater tendency to err on the side of sending people to their GP than the NHS Direct service did, and that that has been at least a partial cause of the increase in NHS demand.

There is great variety in how often people go to their GP. I am not a regular attender, although I have two young children and lean more towards going—and certainly taking them—than I did in the past. I think people generally come to fairly sensible judgments as to when they need to see their GP and when they can deal with a situation themselves or by visiting a pharmacy. I am not sure it is helpful to have a 111 system that leans so far in favour of being on the safe side and recommending people go to their GP. Clearly the 111 operators and the people running that service do not want to be blamed if someone is not sent to a GP or for medical intervention when they need it. On the other hand, they need to understand that if large numbers of people are sent on to those services when they do not strictly need to be, that will mean others do not get appointments and might not get the treatment they need.

Medway has seen significant population growth. We have particular challenges, but I am extremely impressed with our CCG and in particular Dr Peter Green and Dr Nathan Nathan who lead it. They have a go-ahead, ambitious attitude to what they can do both in their commissioning generally within the health service and now in the very positive approach of co-commissioning with GP surgeries, with GPs in the lead. They know best, and it is a very good basis for making commissioning decisions. I recognise the potential conflict of interest GPs have in commissioning for GP surgeries, but it is good to lean more in favour of having services provided in GP surgeries rather than in hospitals. That can be a positive thing, and I hope the three different models and working with NHS England will be a success in getting the right trade-off in this area.

Medway wants to attract and retain more GPs. That involves in part promoting Medway as a place and showing the opportunities it offers, such as relatively good value housing for somewhere as accessible to London, and a very good and improving living environment in both our rural and urban areas. I had the opportunity myself recently to attract quite a lot of publicity to the constituency and in particular to Rochester, which I hope will be to the good.

We must also deal with the large number of single-handed GPs. Some of them deliver very good care, and there are one or two who, in a self-deprecating way, may say there is a reason why they are single-handed when they are pressed to do things differently. Of course, single-handed GPs have a place in our system, but I believe it will be good if we can persuade larger numbers of these single-handed practices, even some of the smaller ones, to work more closely and to amalgamate. They could share the fixed costs, do less administration and be able to see more patients, or even have more time off in some cases.

It is also key to show that GPs in Medway are doing extra and interesting things. I am particularly impressed by the work that has recently been done on familial hypercholesterolemia. I am interested in that because there has been a collaboration between Medway GPs and the charity Heart UK, which was co-founded by my father. I understand that there is shortly to be a study of the success of this programme in Medway in the British Medical Journal. That could be an example to other areas. This work has been able to identify hypercholesterolemia not in one in 750 people as before, or in the one in 500 that was suggested may be the rate across the country, but in close to one in 350. By identifying those who suffer from that condition, we can put in place preventive measures to improve health and prevent heart attacks as well as other negative medical developments. The GPs in Medway should be congratulated on this groundbreaking project, of which I am very proud.

Finally, on the difficulties in getting appointments at our GP surgeries, I recognise that there is no perfect appointment system that everyone will be happy with, but we have a particular challenge in the rural part of the Hoo peninsula. The Elms medical practice has its main centre in Hoo and outposts around the peninsula. I recently talked to people in Allhallows, which is perhaps 10 miles from Strood, and Grain, which is 13 miles away from other care and facilities. There used to be two GP medical practices in Grain, but now there is just one. I understand that it is open only between 9 am and 11 am three days a week, although some people in the village say it may not even always be available during those hours—but I would like to speak to the Elms medical practice before saying anything definitive on that. Similarly, I have spoken to many people on the doorstep in Allhallows and although many are satisfied with their GP services, there is a perception that they are not available for as many hours during the week as they should be, and that one day or morning may be set aside for training at certain times. Again, I will check whether that is correct. People in those areas feel under-served. We have talked about a great increase in demand for GPs, but I am not sure that the supply has responded, at least in these rural areas, where there clearly is a need for greater GP services.

In two practices in Rochester people have faced problems with the booking system. At one, people are not allowed to book in advance by telephone or they find it difficult to get through—a lot of hon. Members will be aware of similar stories. This practice then allows people who come in person and queue up outside to jump the queue of people who are telephoning in. I have seen a large number of elderly and often ill people queuing, before 7.30 am in some cases, to try to get an appointment. That cannot be right and I hope we can find ways of ensuring that people do not have to do that.

At another practice in Rochester a lady called up on 30 January to ask for an appointment only to find that the first one that can be offered to her is on 16 March. Waiting for more than six weeks for a GP appointment cannot be right. I am also told that people who book online have preference, and people such as this lady, who do not have internet access, are clearly at a disadvantage. It is also difficult to get through to the telephone booking system, and then it has eight options and only when someone gets through to option 8 are they even allowed to start making an appointment. I recognise that there is no perfect system, but I hope to work with these surgeries to improve their accessibility to the public. I would also like to thank all the GPs and those who work with them in Medway for the work that they do.

Child and Adolescent Mental Health Services

Mark Reckless Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

The case in my hon. Friend’s constituency highlighted an incredibly important issue. The lessons that are being learned as a result of that incident will result in improved co-ordination and reducing the risk of that sort of thing happening. It was completely intolerable that that young girl ended up in a police cell for that length of time, and we should all be completely clear about that. The crisis care concordat makes the objective clear. We asked every area to sign up—and every area did so by December—to committing to implement the standards in the concordat, one of which is to end the practice of under-18s going into police cells. I think we need to go further and ban it in law.

[Mark Reckless (Rochester and Strood) (UKIP)]

It is just over a year since 35 mental health beds at Medway Maritime hospital were closed. As those closures and the associated changes in Kent were referred to the Health Secretary, will the Minister review whether the changes promised to community care, particularly for some degree of residential provision in Medway, have taken place? Is he satisfied with current provision?

[Norman Lamb]

I am happy to look into that for the hon. Gentleman. Indeed, he can come along to one of my Monday evening advice sessions and we can discuss it further. It is clearly important that the right provision is available in his area.

NHS Major Incidents

Mark Reckless Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

Exactly. We do not want politics to get in the way of what is right for patients, which is what happened when the right hon. Gentleman was Health Secretary. It will not happen while I am Health Secretary.

[Mark Reckless (Rochester and Strood) (UKIP)]

Do we have sufficient measures, short of declaring a major incident, to help to relieve hospitals such as Medway, where there has been an ongoing problem of excessive waiting times at A and E?

[Mr Hunt]

Yes, we have other measures in place. At every stage, trusts should do what is right for patients. Sometimes they declare an internal major incident, sometimes it is an external major incident, but what is important is that they take account of the impact on the rest of the local health economy. At Medway hospital, which the hon. Gentleman mentioned, things are getting better. It has been through a difficult period. We have been honest about the problems, we have given it a lot of external support, and I hope that the news will continue to get better.

National Health Service

Mark Reckless Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mark Reckless (Rochester and Strood) (UKIP)]

My party believes in an NHS free at the point of use and funded out of general taxation. I support much of what is in the motion today. I, too, would question what it states about outsourcing, as it is not quite clear whether outsourcing will be based on hypothecation in relation to how much the mansion tax raises or on how much the Conservatives happen to be spending. I believe we need to decide the right amount to spend on the NHS and then to commit to it, rather than simply say it should be £2.5 billion above however much the Tories spend—either cutting or increasing. We should make a decision about how much the NHS needs and then fund it properly. I support the principle of joining up adult social care with the NHS, and I thought that the shadow Secretary of State made a persuasive case for a single budget.

[Ian Austin]

What does the hon. Gentleman think it tells us about his leader’s instincts when he said:

“I think we are going to have to move to an insurance-based system of health care.”?

Moreover, what does he think it tells us about his deputy leader’s instincts when he said that he wanted to

“congratulate the coalition government for bringing a whiff of privatisation into the…National Health Service…the very existence of the NHS stifles competition.”?

Does that not prove that ordinary people who rely on the NHS cannot regard UKIP as being in any sense on their side?

[Mark Reckless]

It proves nothing of the sort. The hon. Gentleman faces a very strong challenge from UKIP in his constituency from the excellent Bill Etheridge MEP. The policy of our party—[Interruption.] No, let me answer the point. Our policy is determined by our party as a whole. We are committed to an NHS free at the point of use and funded properly out of general taxation. [Interruption.] May I continue? I personally come from a mother and father who met in the NHS; the NHS and supporting it is in my blood. I believe in the NHS as I have described it, and I would appreciate the courtesy of people accepting the sincerity of what I say on that.

I am pleased to see the shadow Secretary of State still in his place as he has been throughout the debate, but when it comes to funding the social care budget, it is a moving target to determine what that budget is. We know the local government settlement for the year ahead, but not for beyond that. We do not know what either a Conservative-led or Labour-led Government might be able to, or choose to, spend on local government, or what proportion might be allocated to public health budgets. It thus strikes me as a significant risk to say, without greater clarity, “This is what the budget will be, plus the sum of £2.5 billion”—the figure selected by the shadow Health Secretary and his party, irrespective of what the baseline is.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Can the hon. Gentleman be absolutely certain of what his party might or might not do should it ever—unfortunately—find itself propping up a Government? Can he assure us that the road to Damascus-style conversion that he is describing represents the view of the whole of his party, and not just his individual view?

[Mark Reckless]

Yes, I can give the hon. Gentleman that assurance. It is the view of my party, it is the view of the whole party, and it is my own personal view, which is core to my politics and what I came to the House to represent.

The Prime Minister said earlier that I came to the House week after week to discuss the NHS in Kent. Following what could perhaps be described as an endorsement of my approach from the Prime Minister, I now wish to raise some of the issues that have arisen in Medway. One of the problems with the motion is that it makes no mention of introduction of the new GP contract in 2004, which I believe has been a significant driver of increased demand for A and E services.

In Medway, where the proportion of single-handed general practices is significantly higher than the national average, the burden of out-of-hours care falls largely on an organisation called MedOCC. While I would encourage constituents to use MedOCC rather than A and E when that is appropriate, I have one or two concerns about the way in which it operates.

Like the hon. Member for Wirral South (Alison McGovern), we had a young child who was ill, and we sought an appointment. My wife telephoned MedOCC and we were offered an appointment at a particular time, but were then told that the wait would be an hour and a half. We said “If the wait will be an hour and a half, why do you not give us an appointment an hour and a half later than the one that you have just given us?” However, that was not allowed. We had to wait for an hour and a half, because that was the procedure, and that was the way it had to be. Although we went to the MedOCC clinic because we thought that that was the appropriate service, I would understand it if a constituent in the same circumstances decided to take his or her chances at A and E, where it might even be possible to be seen more quickly.

It is important for an out-of-hours service—in our case, MedOCC—to be flexible and responsive, and to be operated in a way that makes it an attractive and appropriate alternative to A and E, and I shall develop that point further when I meet members of the clinical commissioning group on Friday.

[Rehman Chishti]

The hon. Gentleman and I share the same hospital in Medway. Will he join me in welcoming the extra £13.4 million that has been given to its A and E department, the extra £6 million of winter funding, and the additional £10 million that has been given to the CCG to help to improve local health services?

[Mark Reckless]

I do indeed welcome those sums; I pressed for them strongly. I was particularly delighted by the provision of that £13.4 million for the rebuilding of the A and E department, which I think is essential. I am now campaigning for the provision of a further sum of approximately £20 million so that the hospital can build what it describes as an “emergency village”, consisting of short-stay medical wards around the A and E to improve the throughput of patients and the quality of care.

I have also helped the hospital with its efforts to ensure that patients are referred more appropriately, and are not necessarily sent to A and E. If a GP refers a patient to hospital and that patient has a known condition, surely it is better for the patient to go to the relevant ward than to be pushed through A and E, which is not an appropriate environment for someone who has already been assessed by a GP. Similarly, A and E is rarely the right environment for people suffering from dementia. It is best for action to be taken at the nursing home or by GPs, possibly based alongside A and E, who can make a speedy assessment and transfer the person to an appropriate treatment area. I am also pleased by the decision to end the so-called Star system in Medway A and E. The idea was that someone would be assessed by a senior clinician before it was decided what should be done, but that was not happening within a sensible time scale. That system has now been replaced by nurse-led triage, which I think will work better.

I am also grateful for the support we have received from other hospitals, notably the Homerton, which has an excellent A and E department. Medway has benefited from secondments there. It is important that those secondments and that support are integrated with the permanent staff in Medway hospital and the clinical director lead for emergency medicine is key.

We have had extra consultants appointed in emergency medicine at Medway hospital, which I strongly welcome, but I must mention the terms and conditions of emergency doctors. It is an extraordinarily demanding specialty and doctors working in it rarely have the opportunity to take on private work, which is a consideration for some but not all doctors when they make their choice of specialty. To encourage more doctors to come in to this field, should we consider changes to the lockstep consultant contract so that doctors in the extraordinarily demanding area of emergency medicine can perhaps receive more pay than others who are in specialties that are not as extraordinarily demanding, to which some might have been attracted by the potential for private earnings that they could not make in emergency medicine?

The Secretary of State tells me that what is actually required is more holidays for A and E doctors. That might be the case, but it would require pulling more doctors in to emergency medicine to cover for colleagues on holiday. I question a system in which high numbers of agency staff are used for a day or a week. Hospitals with problems in A and E and that have problems attracting people can fill places with those staff by paying very high rates, but they do not necessarily gel as a team or provide support in anything but the short term. We need to make emergency medicine attractive for doctors.

Finally, on the question of Monitor and the CQC, Medway hospital is a foundation trust. That happened in a largely box-ticking and financial exercise under the previous Government that ignored the death rate being one in 10 higher than it should have been, as mentioned by the hon. Member for Gillingham and Rainham (Rehman Chishti). Although Monitor has been reasonably sensible in its approach to Medway, it cannot come and run the hospital. We had to look to the board to do that. Similarly, the CQC has made some sensible interventions, for example on A and E, but in 2012 it said that Medway was a good hospital that was meeting all its standards. I believe that many of the problems we are seeing were in place then but were not identified by the CQC. My party wants to replace some of the alphabet soup of bureaucracies and regulators, such as Monitor and the CQC, with directly elected health boards that could, we believe, oversee these things better.

Oral Answers to Questions

Mark Reckless Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.

[Mark Reckless (Rochester and Strood) (UKIP)]

To attract more senior doctors into emergency medicine—an extraordinarily demanding specialty where doctors work solely for the NHS—should we consider paying them more than they get under the standard consultant pay scale?

[Mr Hunt]

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

A and E (Major Incidents)

Mark Reckless Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more that can be done to facilitate discharges and relieve the pressure at Kettering.

[Mark Reckless (Rochester and Strood) (UKIP)]

I greatly welcome the £13.4 million of investment recently signed off for Medway hospital’s A and E department. Does the Secretary of State also understand the hospital’s need for a further £20 million of capital for medical wards around the A and E department to support integrated care and improve the throughput of patients to assist in turning around Medway hospital?

[Mr Hunt]

I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.

NHS (Five Year Forward View)

Mark Reckless Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. The Labour party thought it would win this argument by pledging extra money for the NHS at its party conference, but that will not actually happen until the second half of the next Parliament and it may not happen at all if it has got its sums wrong. The public reaction was simply not to believe it, because they know that what Labour does to the economy actually puts all NHS funding at risk, which is something we must never allow to happen.

[Mark Reckless (Rochester and Strood) (UKIP)]

Earlier this year, the Secretary of State announced a welcome £6.12 million grant for Medway, and on Tuesday he referred to the extra doctors and nurses being taken on in a special measures regime for Medway hospital. Could he assure us that extra and recurring funding will also be available to cover the costs in future?

[Mr Hunt]

The funding I have announced today—the £1.5 billion for front-line NHS services—is recurring, as is the additional Treasury funding of £1 billion. That is being added to the NHS baseline so that it can be invested in long-term increases in staff numbers, among other things.

Oral Answers to Questions

Mark Reckless Excerpts

Tuesday 25th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I would be delighted to meet my hon. Friend and his constituents to review that very important issue.

[Mark Reckless (Rochester and Strood) (UKIP)]

Last month one patient waited 35 hours in Medway’s A and E, and in the past year 10 patients have waited more than 24 hours. I was grateful to the Secretary of State for taking up my invitation to visit the hospital. What progress has been made specifically on turning around the A and E department?

[Mr Hunt]

There are more doctors and more nurses operating at Medway hospital and I know that when the hon. Gentleman was sitting on this side of the House he was very pleased with the progress that was being made in turning it around from special measures, but, like UKIP’s policy on the NHS, everything changes.

National Health Service (Amended Duties and Powers) Bill

Mark Reckless Excerpts

Friday 21st November 2014 Commons Chamber

[Mark Reckless (Rochester and Strood) (UKIP)]

It is a pleasure to speak on this Bill.

[Mr Ronnie Campbell (Blyth Valley) (Lab)]

On this side of the House.

[Mark Reckless]

And indeed on this side of the House.

It is a particular pleasure to speak on a Bill introduced by the hon. Member for Eltham (Clive Efford), because I have spent time in the past few weeks defending myself following allegations from the Conservative party that I grew up in his constituency, in SE9.

[Clive Efford]

You should be proud.

[Mark Reckless]

Indeed, I am proud, and many people in my constituency have moved down from Eltham and the surrounding areas, and I am delighted that they returned me to the House in the early hours of this morning.

I found the hon. Gentleman’s speech compelling. At half-past 4 this morning or thereabouts, I was extolling the virtues of the Levellers and the Chartists. I can only think that I had a premonition of the speech that the hon. Gentleman was to make in the House this morning.

The other reason for my presence here is that, in the by-election I have just fought, we had in Naushabah Khan a Labour candidate who made—quite eloquently, I thought —the case against fragmentation and privatisation of the NHS, and she and others in Medway Labour commended the Bill to me.

[Grahame M. Morris]

I was not in Rochester last night. I joined a vigil outside Parliament by groups who are campaigning to save our NHS, and I had a conversation with a consultant oncologist on that very issue of fragmentation. He said that the only competition we should have in the NHS is the competition to defeat disease. Does the hon. Gentleman agree with that?

[Mark Reckless]

That sounds a good statement. I myself feel a certain degree of scepticism, as the hon. Member for Southport (John Pugh) said, about internal markets in the NHS and other public services. Much depends on the circumstances of the service provided, and an ideological predisposition either against or in favour of internal markets is probably not wise.

The Labour candidate in the by-election opposed fragmentation and privatisation of the NHS, and the Bill appears to do so as well. I have discovered that this is now the Labour party’s position. I had assumed that the Labour party was in favour of fragmentation and privatisation in the NHS, because that was my understanding of what the record had been.

[Andy McDonald]

Perhaps the hon. Gentleman would like to clarify, for the benefit of the House, whether his party is in favour of a private insurance-backed approach to health care or whether it actually believes in the NHS.

[Mark Reckless]

My party believes in the NHS as a service that is free at the point of delivery. My father is a doctor, and my mother is a nurse. That belief is core to my values, and to the values of my party. [Interruption.] That is our policy. Our policy is determined by our party, and it is to support an NHS that is free at the point of delivery.

[Mr Anderson]

When did the hon. Gentleman come to that conclusion?

[Mark Reckless]

I think that the hon. Gentleman may be referring to the answer to a question that was asked two years ago, which is now being taken out of context. Our party is not quite like the Liberal Democrats with their federal policy executive, but we have formal measures for the making of policy, and UKIP has decided—

[Mr Anderson]

Will the hon. Gentleman give way?

[Mark Reckless]

I will continue, if I may.

[Dr Huppert]

rose—

[Mark Reckless]

I will give way to the hon. Gentleman.

[Dr Huppert]

Although I do not agree with the hon. Gentleman on many things, I welcome him back to the House. He has talked about the history and the evidence. He might be interested to know that, according to the House of Commons Library, the amount spent by NHS England on buying health care from outside the NHS rose from £1.1 billion in 1997-98 to £7.5 billion in 2009-10. Those are the facts, according to the Library.

[Mark Reckless]

The hon. Gentleman is correct. There was a great deal of privatisation and, indeed, fragmentation of the NHS under Labour, and I do not deny that there has been more of it under the current Government. I think that it is a problem that has afflicted both main parties.

[Mr Anderson]

rose—

[Mr Donohoe]

rose—

[Mark Reckless]

I will continue for a bit, if I may.

Let me explain how I view the issue from a local perspective. As far as I can see, Darent Valley hospital, which is near my constituency, was privatised under Labour in one of the most disastrous private finance initiatives experienced by the NHS. Medway NHS Foundation Trust became a foundation trust on the basis of what was largely a box-ticking exercise, which focused on finances and appeared to ignore the fact that by that stage the hospital’s standardised mortality rate was some 10% above the norm: one in 10 more patients were dying that should have been expected.

[Mr Donohoe]

I know that the hon. Gentleman had a late night, but can he tell us what is his party’s view of the health service in Scotland?

--- Later in debate ---

[Mark Reckless]

I will clarify the view of my party on the NHS in general, but I am afraid that I am not yet in a position to give details of its policy on the NHS in Scotland. I should be happy to seek to assist the hon. Gentleman on another occasion.

What happened in Medway was fragmentation. The hospital was cut loose by the Department of Health, and is now essentially run by an independent board. When there are problems and it is in special measures, there is now a potential for greater intervention, but we have in Monitor what appears to be a backstop regulator, rather than a regulator that is able to come in and run the hospital and turn it around. It can get rid of the chair and the chief executive, but it cannot make constructive improvements.

[Mr Anderson]

Will the hon. Gentleman give way?

[Mark Reckless]

I will continue, if I may.

The independence of such hospitals, the inability of the House or the Secretary of State to drive improvements, and the decision to allow a hospital to become a foundation trust although one in 10 more people were dying than should have been the case, constitute an indictment of the last Government’s policy. I was delighted to hear from the Labour candidate whom I have faced in recent weeks that Labour is now against fragmentation and privatisation of the NHS. I welcome the Bill, and I am pleased to be able to support it.

[Clive Efford]

I welcome support for my Bill from all quarters, but why should anyone believe what the hon. Gentleman says about the NHS? Does he accept that the Government were elected with no mandate to introduce the 2012 Act, and that he voted for it?

[Mark Reckless]

I think that that is probably correct. I may be guilty of having believed the undertakings I was given by those on the Government Front Bench.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It might be helpful for the hon. Gentleman to bear in mind the words of his colleague, the hon. Member for Clacton (Douglas Carswell), who said:

“Never one to slavishly support the party line, I would be quite prepared to oppose these reforms”—

the 2012 Act—

“if I felt they were a step back. But I won’t. These changes are necessary—and contrary to much of the mainstream media coverage, in my experience they are quietly supported by many doctors too.”

Does the hon. Gentleman support what his colleague said, or does he not?

[Mark Reckless]

I think that my hon. Friend the Member for Clacton (Douglas Carswell) was right in saying that some doctors supported the Bill that became the 2012 Act. During the early stages of that Bill, a number of representative bodies supported it, or were presented as doing so. As the Bill proceeded, however, some of what had been claimed to be support from organisations such as the British Medical Association seemed to fall away. I believe that the Bill ran to 460 pages.

The problem was the way in which legislation is made in the House. The coalition agreement promised us a House business committee, but no such committee deals with the allocation of time for legislation. We have a Committee of Selection, but it is run by the usual channels—the Whips on either side of the House—and people with expertise such as the hon. Member for Totnes (Dr Wollaston), who might actually have improved the Bill, were excluded from it.

[Dr Poulter]

I feel I should quote further from what was said by the hon. Member for Clacton, when much of the Committee stage of the Health and Social Care Bill had been completed. He went on to say—on 11 February 2012, on his TalkCarswell.com website—

“If these proposals were defeated, it would be a setback for all those of us who would like to see public service reform. We need to keep our nerve.”

That rather contradicts what the hon. Member for Rochester and Strood (Mark Reckless) has just said, does it not?

[Mark Reckless]

That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

No, I will continue for a bit, if I may.

I do not think that the extent of the difficulties that doctors and others would encounter as a result of section 75 of the Act and the bureaucratic, market-based—or quasi-market-based—commissioning rules that it requires was any more apparent to my hon. Friend the Member for Clacton than it was to other Members, although some Opposition Members may have had premonitions of it. I thought that the Bill was intended to allow the various local bodies to get on with running the NHS in their areas. Some would run it better than others; there would be local decision-making and discretion, and people would learn from each other. Now, however, there are centrally determined rules that force everyone into, in particular, commissioning or contracting behaviour, but do not make sense in the context of the service that is being delivered.

[Philip Davies]

I congratulate the hon. Gentleman on his victory in last night’s by-election. It was an excellent result for him and it would be churlish not to point that out. I know that he is a long-standing believer in localism. Is he not worried by the British Medical Association’s concerns that the Bill would give much wider powers to the Secretary of State, thereby centralising powers and taking the day-to-day running of the NHS away from clinical staff and putting it in the Secretary of State’s hands? As a champion of localism, is he not worried by that?

[Mark Reckless]

I am grateful to the hon. Gentleman for his congratulations; that is very decent of him. I am not a fan of quasi-autonomous bodies, of great amounts of regulators or of overlapping layers of bureaucracy; they rarely work. Given the degree of complexity that has now been brought into the NHS, I think it is possible—although I am not certain—that the centralisation of power in a single Secretary of State who is at least accountable to the House might be better than the current diffusion and fragmentation of powers, which does not seem to be working effectively. My party would like to replace the alphabet soup of regulators and the overlapping layers of bureaucracy with a single, elected health board for each county area. That would give a degree of clarity to the oversight and management of the NHS.

[Mr Donohoe]

Why does the hon. Gentleman not think that health boards should be taken back into local authority control, where a democratic ticket is already involved, rather than creating a separate vote for stand-alone health boards?

[Mark Reckless]

There is an argument for doing that, and a judgment has to be made. It might be possible, depending on the different areas of the countries—particularly in the devolved Administrations—that the solution to that question might be different. My general view is that it is much better to have democratic accountability than not to have it, and in many areas I would prefer that to be local. My party wants to see health boards elected on a county basis.

My party also wants European competition law to be taken out of the NHS, and the Bill is exemplary in that regard. I strongly support that provision.

I have signed a pledge on TTIP, along with most other candidates in the by-election, except for the Conservative—[Interruption.] No, not the Liberal one—that was not a good one to sign—although I did vote against tuition fees, along with most Opposition Members. I would like to see the NHS excluded from TTIP. There are arguments as to whether it will be or not, but those arguments should be settled in the House as per this Bill, rather than being left to the unpredictability of future legal actions.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

I am just reaching my conclusion, if I may.

The hon. Member for Eltham made a mistake in talking about the UK negotiating on TTIP. That is an area of exclusive competence for the European Community, and it is therefore the EU Commission that will negotiate with the United States on that matter. When I first heard about TTIP, it sounded as though it would be all about free trade and I thought that it would be broadly a good thing. The more I looked into it, however, the more it seemed to be not about free trade but about the creation of a single set of transnational regulations between the US and the European Union, and that it would be illegal for anyone not complying with them to sell goods and services. I am therefore very sceptical about TTIP and I am not sure it is something that I would want to support. I certainly do not want to see the NHS included in it.

I congratulate the hon. Member for Eltham on his Bill, and I look forward to supporting him in the Lobby.

--- Later in debate ---

[Andy Burnham]

We have spineless Government MPs who will not come here today to argue for the Act.

I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on his victory and on being here today, despite being up all night—I cannot imagine that he managed to get any sleep. His party leader has said that when the hon. Gentleman is tired he says things that he does not mean—I think that he just nodded there. Given that he has been up all night, I can only conclude that he does not actually believe what he said in the speech we just heard. In three days he has gone from being in favour of the repatriation of European citizens to being against the privatisation of the NHS. That is a pretty big political distance to cover in just three days.

[Mark Reckless]

I have only ever argued for European citizens to be able to stay; any other words came from others, not me. It is the right hon. Gentleman’s party that has reversed its position, having previously privatised the Darent Valley hospital and fragmented the Medway Foundation Trust, but it now seems to have a better policy, which I am happy to support.

[Andy Burnham]

The hon. Gentleman said that he could not understand Labour’s position, but surely he remembers 2012, when Opposition Members spoke with force against that legislation, which he then voted for in the Lobby. I know that it has been a long night, but he really should try to remember these things, because they are quite important.

[Andy Burnham]

It is a tiring business being an MP and it is possible to forget things, particularly when one drinks as many pints as UKIP Members do, but they should try to remember. Their party leader once said that he would give the NHS budget to insurance companies; apparently, he does not believe that now. The deputy leader, a Mr Nuttall, said that the right hon. Member for South Cambridgeshire was to be congratulated on bringing a whiff—just a whiff—of privatisation to the NHS, and the hon. Member for Clacton (Douglas Carswell), whom the Minister quoted earlier, described the Lansley reforms as “fairly modest”. He chided his Tory colleagues who were sniping against him at the time and said that the reforms must not be derailed. The party says it is anti-politics in the way things are done. This is sheer opportunism and dishonesty.

[Mark Reckless]

I recall much of what the right hon. Gentleman said from the Dispatch Box in 2012, and I would like to credit him because a lot of it has come to pass. He was perspicacious in much of what he said and many of the assurances that I was given from the Government Front Bench have been found wanting.

[Andy Burnham]

I appreciate what the hon. Gentleman says—it would be churlish for me to say otherwise—and I am grateful for the way he said it. The things Opposition Members were saying back then have happened, and we can see the effects of the Government’s reorganisation in the NHS. With the new figures that came out this morning, we see that A and E has missed the Government’s target for 70 weeks in a row. The A and E figures are the barometer of the health and care system. They are the best place to look if we want to see whether there are problems in the health and care system. The fact that the target has been missed for 70 weeks in a row tells us that severe storms are building over the NHS.

--- Later in debate ---

[Dr Poulter]

I have just dealt with it, and I am going to make a little progress.

I want to deal with the contribution made by the hon. Member for Rochester and Strood (Mark Reckless). He failed to address the issues that I had raised earlier about the support that the hon. Member for Clacton (Douglas Carswell), his party colleague, gave to the Health and Social Bill—now the Health and Social Care Act. In fact, as the right hon. Member for Leigh (Andy Burnham) said, the hon. Member for Clacton thought that the reforms did not go far enough. Indeed, the leader of his party is on record as talking about the need, in effect, to privatise our NHS. I would like to reaffirm the commitment that that will absolutely never happen under this Government or any Conservative Government.

Another important point needs to be made. Earlier this week, the hon. Member for Rochester and Strood expressed frankly unacceptable and distasteful views on repatriation. We must of course bear in mind that 40% of staff in our NHS come from very diverse, multicultural backgrounds. We very much value the contribution that doctors, nurses and health care staff from all over the world make to our NHS. I do not want to see those people repatriated; I want to see them continuing to deliver high-quality care for patients in our NHS—something that UKIP clearly opposes.

[Mark Reckless]

I have made absolutely no such remarks; I have said only that we wanted such people to be able to stay. The disgraceful remarks were actually made by the Conservative candidate, who juxtaposed the issues of unlimited immigration and fear of crime.

--- Later in debate ---

[Dr Poulter]

Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.

[Mark Reckless]

rose—

[Dr Poulter]

I think that the hon. Gentleman has said quite enough already, and I need to make some progress.

Let me move on to the second, substantive, point in this debate, on which I hope there will be a large amount of agreement. It was articulated—

[Mark Reckless]

rose—

[Madam Deputy Speaker]

Order. The Minister is not giving way.

[Dr Poulter]

Thank you, Madam Deputy Speaker.

The point was articulated very well by my right hon. Friend the Member for Banbury (Sir Tony Baldry) in one of the best and most accurate speeches of this Parliament in an NHS debate.

[Mark Reckless]

On a point of order, Madam Deputy Speaker. The Minister has made a false allegation to which he has not given me the right of reply. Of course I welcome all those immigrants in the NHS. They are very welcome and we want them to stay as much as he does.