Paul Burstow
Main Page: Paul Burstow (Liberal Democrat - Sutton and Cheam)Department Debates - View all Paul Burstow's debates with the Ministry of Defence
(10 years ago)
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Paul Burstow (Sutton and Cheam) (LD)
My hon. Friend is setting out the important changes that have been made in the Lords on the trust special administration process. He might consider giving further emphasis to the point that Earl Howe made in relation to all the steps that would be taken prior to the consideration of a trust special administration process being put in place, not least the intervention powers of Monitor and others.
Norman Lamb
Given that time is tight, I simply confirm that I strongly support what Earl Howe said in the other place, and reinforce the points that my right hon. Friend has made.
For NHS trusts, clause 118 already requires the Secretary of State to produce guidance on seeking commissioner support and involving NHS England, and we will ensure that the key principles of parity between affected commissioners and the essential services they commission are captured in the guidance. I urge the House to support the Lords’ amendments.
Mr Reed
Indeed. My hon. Friend knows about these issues in detail. That is why we have asked the questions that we asked and tabled our amendment on Report.
With reference to parts 2 and 3 of the Bill, the insertion of the hospital closure clause—the Lewisham clause, clause 119, formerly clause 118, call it what you like—is extremely regrettable. It is because of this that the comparison with Frankenstein’s monster has been made, and because of this that we have tabled further amendments today. This House, the people of this country and every hospital league of friends, local hospital action group or other such groups working for the benefit of health services local to their area—and I include in that the magnificent campaigners in Millom and around the West Cumberland hospital in Whitehaven —will never forget the genesis of the major policy change that this clause represents, namely Ministers’ attempts to close good services at a well performing hospital against the wishes of the locally affected public, patients and local clinical commissioners.
On attaining office, the Government made a series of grand promises about future changes to hospital services. The coalition agreement stated:
“We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.”
GPs were meant to be placed in decision-making roles and given the power to shape local services. As with so much that this Government do, the rhetoric could not be further from the reality, and far from stopping centrally dictated closures, they are now legislating to make it easier to close local hospitals and remove hospital services.
Clearly, a failure regime is essential and when things go wrong, they must be put right, but to attempt to short-circuit the existing reconfiguration framework, and to actively seek to disfranchise patients and the public, is not the way to improve services. Riding roughshod over local commissioning in order to reconfigure an area’s health services is not the way to build support for change. Deliberately ignoring the voices of local patients is a recipe for more expense, uncertainty and delay.
Take the example of Lewisham. Much has been said in this place about the process, the legal judgments and the amazing work undertaken by local campaigners there, so I shall not go into too much detail. Suffice to say that the Government’s attempts to use the law for a purpose for which it was never designed were described as “strained and unnatural” by Lord Justice Sullivan when dismissing the Government’s appeal against their original defeat. I would be grateful if the Government could explain why they believe the most effective way to deal with a failing trust is to alienate local commissioners, the local community and local health professionals. Rather than bringing stakeholders to the table to form a solution with regard to Lewisham, the Secretary of State dragged them through the courts and lost, twice.
Having been beaten by the law, the Secretary of State has decided to change it. The simple truth of the Government’s hospital closure clause is that a successful local hospital, the type that the Secretary of State enjoys getting his photograph taken in, can be closed without due process, simply because the one down the road is in trouble. It is as logical as removing a patient’s leg to cure a headache. Despite their valiant defence of the clause as it stood on Second Reading, the Government have been forced to make what they call major concessions, which are in reality very minor concessions.
Lords amendments 40B to 40E seek to ensure that “essential services” are not harmed. We are told this would mean that if a local commissioner believed that the trust special administrator’s recommendations would harm essential services, they would not be implemented—unless, of course, NHS England overruled the local commissioner. Our amendments to Lords amendments 40B and 40C would ensure that any recommendations would not be able to go ahead if they in any way restricted access to services, and that all correspondence between commissioners and the trust special administrator would be made public. Making it harder to use services is the very antithesis of the principles underpinning the NHS, which the Government claim to support—but only when it suits them.
We should judge this Government not by their words, but by their actions. They promised no top-down reorganisation. They delivered the biggest, most wasteful, most expensive and chaotic reorganisation in the history of the service. They promised a bare knuckle fight to protect local services. They delivered a back-door reconfiguration tool that could facilitate the largest ever hospital closure programme. They promised that local decisions would be made by local commissioners. They delivered a power for the Secretary of State and NHS England to overrule local commissioner vetoes. All this was done against the advice of medical professionals, against the wishes of the public and against every pre-election promise, and therefore without a shred of legitimacy.
The TSA process was introduced in 2009 and was intended, as the High Court ruled, to be used to make quick changes to management structures in order to address financial failures, not to make widespread service reconfigurations possible without public input.
Mr Reed
I will make some progress.
The only way to build sustainable services is to have widespread ownership of changes and a robust process of community engagement. The Government’s disfigurement of the TSA process will mean that they have to give no regard to patients’ wishes, and in practice it will mean that they can disregard the views of local commissioners. If the Secretary of State wants to close a hospital, it will be done. It is as simple as that.
In 2003 Labour created the independent reconfiguration panel, a non-departmental body to advise on service change. The IRP’s terms of reference when reconfigurations are proposed state:
“The panel will consider whether the proposals will provide safe, sustainable and accessible services for the local population, taking account of:
1) Clinical and service quality
2) The current or likely impact of patients’ choices and the rigour of public involvement in consultation processes, and
3) The views and future referral needs of local GPs who commission services, the wider configuration of the NHS and other services locally, including likely future plans.”
Why does the Minister think reconfigurations of whole health economies should not be subject to independent scrutiny by the IRP? Why does he think that this should be bypassed without local agreement? Given that quality issues are subject to a number of investigations before a TSA would be appointed, such as Care Quality Commission investigations and being placed in special measures, why cannot a thorough investigation of reconfiguration options be put to the IRP and the public?
If the point of centralising a reconfiguration decision is to provide a quick solution, why are not the Government open to consultation with the public on the future of their local health services during the process of inspection by the CQC or the extended period of time during which a trust is in special measures? Speedy resolution of care failures is essential, but to go along with the Government’s proposals would be to suggest this sense of urgency appears only after months of work trying to address the problem. That is wrong, and it is little wonder that so many hospitals and so many communities believe that this legislation is setting them up to fail.
The Government’s position on this is intellectually dishonest. In reaching the conclusion that the TSA process should be hijacked to provide a back-door reconfiguration tool, they have wilfully ignored professional, legal and medical advice, and have disregarded existing procedure. They have cost the taxpayer hundreds of thousands of pounds in defending their decision in the courts and they have added to the chaos into which they have already plunged the NHS. On Report we offered to work with the Government on a cross-party basis to produce a reconfiguration process and a TSA process that would have commanded broad public and political support. This offer was rejected.
The Opposition’s amendments seek to make a bad law slightly better, but the truth is that more lifeboats on the Titanic would not have stopped it sinking. In case any Government Members ever actually believed the coalition agreement, a vote against our amendments today is a vote against that agreement. At their heart, our amendments are an attempt to help the Government to help themselves, but more importantly, to help all of those communities who expect to have a say in the future commissioning of their local hospital services. The next Labour Government will ensure that their voice is heard.
Paul Burstow
Listening to the hon. Member for Copeland (Mr Reed), it struck me that the Care Bill could be described as a Bill that was full of ideas that were proposed by the Labour party when it was in government, but was a modest measure. In some ways, I find those two positions contradictory, unless of course the last Government were not the bold, revolutionary Administration whom they often told us they were when they were in office. If we are indeed in a zombie Parliament, that is characteristic of the languid nature of opposition offered by the Labour party.
Paul Burstow
I hope the hon. Lady will forgive me, but I will make some progress, just as the hon. Gentleman did earlier.
Amendment 11B concerns the Human Rights Act, and I thank Ministers for keeping an open mind and for listening seriously to the concerns raised by Lord Low and others, and to me and other hon. Members who were concerned that an opportunity was being missed to close a gap. Legislation under the previous Government partially but not completely closed the gap, as a result of which those cared for in their own homes did not have the benefit of Human Rights Act protection. The amendment, which was agreed without a vote in the other place, gives that protection. It is the end of a story of seven years of dealing with a gap in the law that was opened by a court judgment. I am grateful that, notwithstanding the difficulties of our bicameral parliamentary process, it has worked at its best on this occasion, because it has meant that concerns raised through the Joint Committee that I chaired, through the Joint Human Rights Committee’s report and by Members in the other place, have now been comprehensively addressed.
Having said that, will the Minister confirm that a person who avails themselves of provisions in the Bill that allow them, as a self-funder, to ask their local authority to arrange their care at the point at which they start to benefit from the means-testing arrangements, and therefore have some support from the local authority, will then be covered by the Human Rights Act?
I would also like to thank the Minister for listening carefully to what has been said at each stage in the passage of the Bill, in both Houses, in respect of the trust special administration regime. It is important to emphasise that the approach set out by the previous Labour Government recognised that trust special administration was a last resort. Earl Howe has emphasised that in the other place. He was very clear that there are powers available to the Trust Development Authority and to Monitor to intervene as necessary in order to avoid trust special administration ever being triggered in the first place. I commend to Members the passage in House of Lords Hansard in which he sets out clearly all the steps that would need to be taken:
“Trust special administrators would be appointed—and I make this point emphatically—only when all other suitable processes to develop sustainable, good healthcare have been exhausted.”—[Official Report, House of Lords, 7 May 2014; Vol. 753, c. 1496.]
It is worth picking up on the point made by the hon. Member for Copeland. Having been given the opportunity to chair a committee looking at the guidance, I think that some of the points he made in his amendments today are exactly the sort that ought to be given proper consideration in the guidance. I hope that he, other Front Benchers, and indeed other hon. Members who have experience of the only two trust special administration processes that have taken place to date, will offer the committee their views and insights so that we can ensure that the advice we give the Government on guidance is as good and as clear as possible.
As was made very clear in the other place, we are not talking about a power that will effectively enable a wholesale reorganisation of the health economy. The Bill is very clear that this is about those matters that might require necessary and consequential changes. The amendments that were agreed in the other place, without a vote, make it clear that the essential services of trusts that find themselves drawn into a trust special administration process will be a proper consideration in the decision-making process.
It is curious that the Labour party now seems to want us to look at access in a different way from the way in which the trust special administration process that it put in place provided for. In other words, why was there no test on access with regard to the trust that was in special administration under its arrangements? Why did that not matter then but does matter now?
I think that the Government have listened very closely to what has been said and changed the Bill in a way that reflects the concerns that I described on Report. We will have the chance to comment further on the guidance—I hope that the hon. Member for Lewisham East (Heidi Alexander) and others will offer input into that—which will give us another opportunity to ensure that it is as tight and effective as possible on those very rare occasions when it is used.
I hope that consideration of the Bill will be concluded today and that it will make the difference to well-being, as a central principle, and to parity between those who receive care and those who give it. That is what the Bill does, and they are great things, and it is about time that they were on the statute book.
Heidi Alexander (Lewisham East) (Lab)
My hon. Friend the Member for Copeland (Mr Reed) has already set out the case for the Opposition’s amendment in lieu of their lordships’ amendments regarding the TSA regime, and I wholeheartedly agree with all that he said.
I would like to focus my remarks on why I believe that their lordships’ amendments do not undo the damage that lies at the heart of clause 119. While some people—I would probably include the right hon. Member for Sutton and Cheam (Paul Burstow) in this—seem to think that their lordships’ amendments are something of a cause for celebration, in my view the changes fall far short of what is really needed, which is the complete deletion of clause 119. Even with these latest amendments, clause 119 removes the legal protection for hospitals that face the axe because they happen to be located next to a failing trust that has been placed into administration. We know that this legal protection was vital in the case of Lewisham. The Government, having been told by the courts that they broke the law, are now simply changing the law so that in future they can close much-needed services in successful hospitals to deal with financial problems in others.
It has been suggested that the Lords amendments to clause 119 arose from discussions sparked off during debate on Report in this place. Yet the new clause we discussed then, which was tabled by, but then not supported by, the right hon. Member for Sutton and Cheam was very different from what is before us today. Of course, we all remember what happened last time: the Lib Dems were simply bought off with the offer of chairing a committee. It is therefore worth comparing what we discussed on Report and what we are debating now. If I recall correctly, the new clause that the right hon. Gentleman had in his name a month or so ago proposed that the commissioners of services in hospitals that fall outside a trust in administration should have, in effect, a power of veto over recommendations put forward by an administrator.
Paul Burstow
No, it did not. It provided for parity of esteem between commissioners of affected trusts compared with the commissioner of the service that was failing.
Heidi Alexander
I am grateful for the right hon. Gentleman’s intervention. I pressed him on this very point on 11 March, when I asked whether his new clause
“would provide a direct veto to commissioners of services at a hospital located outside the trust to which an administrator has been appointed.”
He responded:
“That is the intention, so the new clause has been drafted to have that effect.”—[Official Report, 11 March 2014; Vol. 577, c. 244.]
The new clause proposed in March—we had a full debate and discussion about it—suggested that if the commissioners were content with the proposals put forward by a TSA, full public and patient consultation would kick in, whereas if the commissioners were not content, they would call a halt to the process. As I said, I pressed the right hon. Gentleman on that, and he was clear in the remarks that he made at the time.
That is not what we are debating now. The amendment that was passed in the other place last week gives statutory consultation rights to commissioners of services in hospitals that fall outside the trust to which an administrator has been appointed. It suggests that changes to essential services that are proposed by the administrator but delivered outside the failing trust should not be caused harm, while seemingly leaving the definitions of “harm” and “essential services” to NHS England. The amended clause states that, should there be a difference of opinion between commissioners, NHS England will act as some sort of referee and have the final say.
I contend that what we have before us today is very, very different from what was mooted in this place on Report. The changes to the Bill that the Government have introduced in the Lords are minor at best, and confusing and irrelevant at worst.
Heidi Alexander
The right hon. Gentleman is shaking his head, and I can see that he disagrees with me about this, so let us look at the committee which has been set up and which he is chairing. Is it actually going to make any difference? My fear is that it is just camouflage for the fundamental damage that will be caused by clause 119. The committee will supposedly look at the rules that govern the use of the trust special administration regime. The most important rules that govern the use of the TSA regime are being set today, in this House and by this Bill.
Paul Burstow
I am grateful to the hon. Lady for giving way; she is being very gracious. The reason the Lords amendment is important is that it makes it clear that essential services in other trusts are now relevant to the guidance at which my committee will be looking.
Heidi Alexander
One person’s definition of “essential” might not be the same as that of another person.
The Lords amendment tinkers at the edges of clause 119. Although it offers some marginal improvement on the Government’s original clause, it does not go far enough. I would vote for deletion again if I could, but parliamentary procedure does not afford me that opportunity. There is no doubt in my mind that this clause, even with the latest amendment, will allow more fast-track hospital closures in future. It removes the protection that existed in law, which allowed Lewisham council and the Save Lewisham Hospital campaign to take a case against the Government and win.
The latest amendment may guarantee another layer of consultation, but it contains no overall guarantee that services will not be closed at successful hospitals to balance the books elsewhere. Is the Minister or the right hon. Member for Sutton and Cheam able to say unequivocally that had this amended clause been on the statute book at the time of the TSA regime in south London, the future of Lewisham’s A and E and maternity service would have been secure? They cannot, because it is not the case.
In conclusion, I do not accept that their lordships’ amendment provides the protection that some believe it provides. The amended clause still extends and augments powers for TSAs and NHS bureaucrats. Even with the increased checks and balances contained within their lordships’ amendments, the TSA process is still a chaotic and rushed mechanism for closing hospital services. It plunges local health economies into desperate uncertainty and takes power away from the public and clinicians.
I do not believe this is the way to make the sorts of changes our health service requires to meet the challenges of the 21st century. I have maintained that position throughout the passage of the Bill and I make no apology for sticking to my convictions to the end. The public do not want more fast-tracked hospital closures, but this Bill legislates for them.