Health and Social Care

Robert Walter Excerpts

Monday 13th May 2013 Commons Chamber

[Nicholas Soames (Mid Sussex) (Con)]

I am grateful for the opportunity to speak in the debate on the Address.

In nearly 30 years in the House, it has been my experience that Governments are always accused of having either too much or too little in their Queen’s Speeches. As my hon. Friend the Member for Banbury (Sir Tony Baldry) rightly said in his excellent contribution, however, they are works in progress. I congratulate the Government on bringing forward a measured and carefully thought-out programme, which has been welcomed by my constituents and which will make a positive contribution to the lives of many of our fellow citizens. The immigration measures, the national insurance contributions Bill and the deregulation Bill are particularly important to the work that the Government are doing—in my view far more successfully than they are being given credit for—in fixing the British economy, which is showing clear signs of real improvement.

I would like to report to the House that at the Burgess Hill Business Parks Association business exhibition on Friday there was a solid mood of determination to grow our local economy, as well as considerable satisfaction at the progress being made. The message that I take back from that admirable gathering is one that all our colleagues will find when they go to gatherings of that type: people want the Government to press on with getting rid of regulation and bringing in lower taxes—above all, they want to get on with growth. This Queen’s Speech presses on with a number of key reforms on welfare, on education and by the Home Secretary in her excellent work on immigration.

We were fortunate to have exceptionally good local election results in Mid Sussex, where the combination of a prudent and well-run West Sussex county council and an extraordinarily efficient and well-led district council have delivered with confidence the Government’s agenda, which is welcomed and well understood. What is clearly most important locally, however, is the state of the economy. For all of us, that must be at the very top of all our constituents’ concerns about the future of the country. Our constituents want the Chancellor and the Prime Minister to press on. If they do and the economy grows, much of the country’s serious anxieties will begin to disappear like the winter snow.

I am delighted that my right hon. Friend the Prime Minister is in Washington today with President Obama in our pursuit of the European Union-United States free trade agreement, which is clearly extremely important to our future, not only for our national trade and commerce in Europe and elsewhere, but as a mark of stability in world trade, which is vital to the ordinary conduct of economic and world trade growth. All of us here know that the opportunities in that regard are enormous.

[Mr Robert Walter (North Dorset) (Con)]

Does my right hon. Friend agree that if we were to vote to leave the European Union, we would no longer benefit from that free trade agreement?

[Nicholas Soames]

I do agree, but I will come to that point in a moment, if I may.

As co-chairman with the right hon. Member for Birkenhead (Mr Field) of the cross-party group on balanced migration, I warmly welcome the considerable progress that the Government have made on the difficult and sensitive matter of immigration. They have succeeded in driving down numbers and there is real progress, but there are no easy solutions. I welcome the carefully thought-out work of my right hon. Friend the Secretary of State for Health on those services. The cross-party group, and I think most of the House, knows that the most careful attention must now be paid to the question of access to benefits and the health service. Thus, the immigration Bill is an important step forward.

I know the Government do not underestimate the anger and frustration that many people feel about too many people arriving in Britain and accessing public services before they truly should. To that end, I will conclude by saying a few words about the European issue.

The House knows that I am a staunch but not uncritical pro-European. I acknowledge the profound frustration of dealing with Europe, and there are certainly the most serious problems with the European Union that we must fix. The Conservatives are committed to doing that. In many of these matters, we will find solid support across the continent from our European partners, and my right hon. Friend the Prime Minister will do that.

People need to understand that the Prime Minister has committed to the negotiation of a new settlement between Britain and the European Union. People questioned whether he would veto an EU treaty, but he has vetoed an EU treaty; people questioned his ability to get the EU budget cut, but he has succeeded in getting it cut; and people questioned his ability to get powers back from the EU, but the fact is that he got us out of the EU bail-out mechanism and saved this country hundreds of millions of pounds.

The Prime Minister has said that he is committed to negotiating a new settlement for Britain within the EU and I have every confidence that that is precisely what he will achieve. It will be then for the British people to judge that settlement in a referendum. There will be a referendum on our membership of the EU; the commitment on that is absolute. Some of my hon. Friends and indeed some of my right hon. Friends need to be a little cautious about trivialising what is involved. The decision on a referendum is hugely important for this country; it is probably the most important decision that it will have to take for generations. It is not to be lightly taken, or on the basis of prejudice or pub rhetoric.

--- Later in debate ---

[Mr Robert Walter (North Dorset) (Con)]

I would like to talk on two issues that, although not included in the Queen’s Speech, will come before the House in this Session, one of which needs to be addressed with some urgency.

In 2005, the European Court of Human Rights ruled that Britain’s automatic blanket ban on the right of prisoners to exercise their vote was incompatible with the convention on human rights, of which we are a signatory. Almost eight years on, the United Kingdom has still not acted on that ruling and time is running short. The Government must submit their response to the Council of Europe’s Committee of Ministers by 30 September. We have less than five months to prepare and present a formula that will be not only satisfactory to the Committee, but acceptable to Parliament and credible in the eyes of the British public.

I would like to state from the outset that I disagree with the ECHR ruling. I believe that the current ban on prisoner voting, which was ruled on and reinforced by successive Parliaments, is a proper and proportionate response following conviction and imprisonment, and I spoke and voted accordingly when the House last debated this matter. I repeat that to my mind the right to vote is not an intrinsic right, but a civic duty reserved for responsible citizens. However, we cannot talk of individual duty and responsibility in the eyes of the law while shirking our national obligations to uphold the international rule of law, one of the basic tenets of British foreign policy. Here is the troubling paradox: if, as the old maxim goes, no man is above the law, surely no country is either. I welcome the fact that this Government, unlike their predecessors, have recognised this responsibility, and I am pleased that the draft Bill on prisoner voting has been presented and that a Joint Committee will consider its options, but I am concerned that matters are progressing slowly against a swiftly approaching deadline and that we are not making a strong enough case for a pragmatic solution.

If the Government choose to maintain the status quo, we will stand in breach of the convention. If we ignore the judgment, we send the message that dissent is an acceptable state of play, and we would damage our reputation and lose the moral authority to demand compliance from those countries that persistently violate international law. Do we want our record on observing the rule of law compared with that of Russia, Ukraine, Turkey, Azerbaijan and Armenia? It would be neither right nor desirable, but a solution might be closer to home than we think.

Before the blanket ban came into force under the Representation of the People Act 1969, limited forms of prisoner voting were permissible and even practised. The Forfeiture Act 1870 disqualified convicted felons from voting, but only those serving a sentence exceeding 12 months. Felons serving less than 12 months could legally vote, and where it was practically and logistically possible, some indeed did. In the 1950 general election, for example, postal ballots were returned from prisoners in jails across the country.

There is more. When the Criminal Law Act 1967 abolished the distinction between felonies and misdemeanours, the concomitant disqualification on prisoner voting came temporarily to an end. In fact, all prisoners could vote. In effect, these prisoners had the right to vote, and it might surprise people that this was not an unintended consequence of the legislation, but a conscious decision based on a recommendation by a law review committee that the practice of prisoner disfranchisement should not continue.

That policy continued until a ban was introduced in 1969 under the Representation of the People Act, but the point is that the issue was not historically set in stone—not under the Forfeiture Act and not when the United Kingdom signed the convention in 1950—so past precedents should lead the way. To this end, the Government’s proposals on minimum thresholds are worthy of consideration, as they reflect an approach that was deemed compatible with UK law, public opinion and the convention, but we need to step up the dialogue.

How, then, do we move forward? I believe that the distinction between felonies and misdemeanours is obsolete, but the classification of crimes into indictable and summary offences, which distinguishes between grades of crime, mode of trial and punishment available, continues to apply. Like the old felonies, the most serious indictable crimes are tried before a Crown court, and I believe that this distinction could be used as a building block for a sentence-based solution that recognises the gravity of an offence committed. This is a route that we should consider, and the United Kingdom now has an advantage: the European Court recently reaffirmed its commitment to allowing the UK greater flexibility in how we apply the ruling, providing an opportunity to develop a policy that reconciles both principle with pragmatism and which allows our past to pave the way forward.

[Mr Christopher Chope (Christchurch) (Con)]

I think my hon. Friend has made a constructive contribution, but would he accept that what he is saying is totally at odds with what the people of this country believe? They do not want prisoners to have the vote and they do not see why European judges should be bossing them around and telling them otherwise.

--- Later in debate ---

[Mr Walter]

I do not see why European judges should be bossing us around either, but if we stick to the principle that we should do nothing that we did not already do when we signed the convention back in 1950, then we have a pragmatic way forward to deal with the problem.

I said I wanted to deal with two issues. I want to say a few words to those of my colleagues who are often banging on about Europe. Let me remind them that divided parties do not give the electorate confidence and are generally not re-elected. If those colleagues genuinely want a referendum, they should rally behind the Prime Minister, who has a clear commitment to address the European Union’s institutional deficiencies and to get a better deal in Europe and then put that to the people of this country in a referendum. Carrying on in this mode is a sure-fire way to give Nigel Farage job security, for we will keep UKIP in business for ever if we undermine the Prime Minister and lose the next election. Perhaps some of my colleagues enjoy banging on about Europe and are not interested in the Prime Minister’s endeavours to find a solution, but they will have plenty to bang on about if we have another Labour Government. If they sincerely believe that what we want is a referendum on Europe, let me tell them that the only way we will achieve that is to return a Conservative Government. Therefore, I shall not support the amendment that has been tabled, although not yet selected; I shall definitely be supporting the Prime Minister.

Community Hospitals

Robert Walter Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Robert Walter (North Dorset) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. I also congratulate the Minister on her appointment, and all of us who are committed to the future of community hospitals look forward to her comments in a few moments. This is not a party-political debate—I hope—but the complete absence of Labour Back Benchers probably explains the difficulties that we had in promoting the case of community hospitals during the 13 years of a Labour Government.

In an age when large organisations seem to be swallowing up smaller ones, it is refreshing to find that in my county of Dorset we have 11 small hospitals, what we used to call cottage hospitals but now refer to as community hospitals. The term was coined in reaction to the hospital plan of 1962, which pressed for resources to be concentrated into hospitals of 300 beds or more, an inevitable consequence of which was the closure of smaller ones. Opposition to this came from the newly formed Association of General Practitioner Hospitals, now the Community Hospitals Association. It was the association’s chairman at the time, Sandy Cavenagh, who revealed that more than half the patients treated in general hospital beds could be cared for equally well or better—and at lower cost—in a small hospital near their homes.

Community hospitals survived, especially in my area, the south-west, which has 80 of the 300 or so remaining such hospitals. Dorset’s 11 community hospitals compares favourably with larger and richer counties. Two of the jewels of this array of community hospitals are in my constituency in Shaftesbury and Blandford, and with the greatest respect to the hon. Member for Southport (John Pugh), a little bit of history is important here.

In Shaftesbury there was no formal provision for the sick of the town until 1874. There had been an infirmary in the abbey, but that disappeared along with the abbey itself during the dissolution in 1539. After that there was nothing until the building of the workhouse in 1840, and its sick ward was only for the inmates. So when the Marquis of Westminster’s widow and daughter wanted to honour his memory, a cottage hospital for those in and around Shaftesbury seemed appropriate. The marquis had owned large estates in the area and had done much to improve the lot of his tenants, and this project was in keeping with his philanthropic attitude. His widow, the dowager marchioness, therefore gave the area the land. The foundation stone was laid in 1871, and the hospital was formally opened by the bishop of Salisbury three years later. It was originally designed for a mere six patients, the poor of the town, and it was anticipated that they would be attended by their own doctors. The hospital was run by the matron—as indeed it is today.

The building was enlarged in 1907. An operating theatre, donated by another dowager marchioness of Westminster, was opened. It is still there, but it is no longer an operating theatre. The hospital’s running costs increased, and the Shaftesbury carnival committee stepped in, and for many years the proceeds from the carnival were donated to the hospital. The committee was rather more powerful than would be expected of such a body nowadays. Indeed, in 1923, it disapproved so strongly of the matron that it refused to hold a carnival that year. The resulting loss of revenue meant that the hospital had to be closed, and the matron then resigned.

Similarly, before 1889 Blandford did not have anywhere to look after the sick and its hospital was funded by the Portman family, which generously donated the land and buildings for the hospital. The present site of the hospital was given by the second Viscount Portman.

About 1,500 patients pass through Shaftesbury hospital, and the friends organisation, which I commend, has estimated that what is done in that hospital saves more than 60,000 miles of travel that would otherwise be covered going to Salisbury district hospital. Such journeys are expensive, stressful and inconvenient to patients, and of course involve unnecessary car use. In its present role, that hospital serves 18,000 patients a year, and the other hospital in my constituency, at Blandford, is thought to serve about 20,000 every year.

The key issue I would like to address is the ownership of these hospitals. Currently, all Dorset’s hospitals are run by Dorset HealthCare University NHS Foundation Trust, which was originally a mental health trust. When the clinical commissioning groups are up and running, the GPs, who are key to the development of today’s community hospitals, should be recognised again as part of the community, and the community hospitals should be owned by the communities they serve. The friends organisations are key to equipping our local hospitals and at the core of that community interest. I believe that we should harness their enthusiasm and expertise, along with that of GPs, in returning ownership of our community hospitals to the communities they serve.

Health and Social Care Bill

Robert Walter Excerpts

Tuesday 20th March 2012 Commons Chamber

[Mr Burns]

I appreciate the hon. Gentleman’s intervention, but I am afraid I do not share that view. I hope that what I shall go on to say will help to give him additional reassurance on that.

There will be additional safeguards in the Bill to ensure that those processes are transparent, including the regulations that Monitor will enforce on procurement practices and its accompanying guidance. In addition, the board must publish guidance for CCGs on their duties in relation to the management of conflicts of interest. Of course, the CCGs' commissioning intentions will have been set out in its commissioning plan, which is subject to consultation with both the public and the health and wellbeing boards.

The second area in which the other place has strengthened the Bill relates to the duties placed on commissioners to ensure a patient-focused NHS. It has always been the Government’s intention to put in place reforms that support the simple principle, “No decision about me without me.” To achieve that, commissioners will for the first time have a duty in relation to patient involvement in decisions. The House strengthened those duties following the listening exercise, and they were further improved by amendments 19, 32 and 33 in the other place, to make it explicit that the duty means promoting the involvement of patients in decisions relating to their own care or treatment.

Another core principle of the White Paper was the need to eliminate discrimination and reduce inequalities in care. The Bill will for the first time in the history of the NHS place specific duties on the Secretary of State and commissioners to have regard to the need to reduce health inequalities.

To reinforce that further, the other place agreed amendments 22, 23, 36, 37, 38 and 60. These ensure that the Secretary of State, the board and CCGs will be better held to account for the exercise of these duties through their annual reports, the board’s business plan and, in the case of CCGs, their commissioning plans and annual performance assessment by the board. However, improvements in quality, outcomes, and reduced inequalities will not happen unless we better integrate services for patients. That is why we placed duties on commissioners, again for the first time, to promote integration in new sections 13M and 14Y, and made clear, following the listening exercise, that competition will not take priority over integration.

[Mr Robert Walter (North Dorset) (Con)]

I met GPs and consultants in Tavistock in west Devon the other day. One of the great concerns that consultants have, particularly in the field of paediatrics, is the integration of children’s services. A great deal of work has gone into that. In dealing with these amendments, what assurance can my right hon. Friend give that the integration of children’s services will be particularly emphasised in these changes?

[Mr Burns]

I hope that my hon. Friend will be reassured by two points. First, the Bill contains far greater duties and responsibilities for integration over the whole provision of care within the NHS, and that will obviously include children’s services. Secondly and more precisely on the narrow issue that he raised, the children’s health outcomes strategy, published some time ago, will ensure that commissioners provide services to improve integration and that there is greater working together between the NHS, public health bodies and commissioners in securing an improved pathway of care and greater integration.

Lords amendment 320 ensures that the NHS continues to provide funds to local government for investment in community services at the interface between health and social care.

Thirdly, amendments in the other place have placed a greater emphasis on the duties of the Secretary of State and commissioners with regard to system-wide issues, such as education, training and research. Amendment 7 ensures that the Secretary of State will remain responsible for securing an effective system of education and training. Amendments 21, 26, 35 and 42 will place duties on the board and CCGs to have regard to the need to promote education and training, and the Government supported the noble Lord Patel’s amendment to ensure that providers of health services were required to participate in the planning, commissioning and delivery of education and training.

The Government have also listened further to concerns that the strength of the research duties on the Secretary of State, the board and CCGs did not properly reflect the importance of the NHS as a world leader in supporting research. Amendments 6, 20 and 34 have strengthened these to a more direct duty to promote research.

Fourthly, concerns were expressed in the other place about the treatment of charities, other voluntary sector organisations and social enterprises that provide or want to provide NHS services. We are committed to a fair playing field for all providers of NHS services, regardless of their size or organisational form. We see voluntary organisations and social enterprises as key to this vision. For example, they can play a key role in understanding the needs of local communities and delivering tailored services.

Amendment 8 commits the Secretary of State to undertake a thorough and impartial statutory review of the whole of the fair playing field for NHS-funded services. I can confirm that it will cover all types and sizes of provider, including charities, social enterprises, mutuals and smaller providers. It will consider the full range of issues that can act as barriers for providers, including access to and cost of capital, access to appropriate insurance and indemnity cover, taxation and access to the NHS pension fund. The Secretary of State will be required to keep consideration of these issues under review. As my noble Friend Earl Howe set out in another place, during preparation of the report there will be full engagement with all provider types, commissioners and other interested stakeholders to ensure their concerns are looked at.

Finally, I turn to the amendments relating to mental health services. I would like to thank my noble Friend Lord Mackay for his work in developing amendment 1, which inserts the words “physical and mental” into clause 1 in order to promote “parity of esteem” between physical and mental health services. In response to the Royal College of Psychiatrists’ concerns, I would like to offer the reassurance that the definition of “illness” in section 275 of the National Health Service Act 2006 would continue to apply to section 1, meaning, for example, that learning disabilities, mental disorders and physical disabilities would continue to be covered by the comprehensive health service.

Although our view is that the most important work in achieving genuine parity of esteem will be non-legislative—for example, through our recent mental health strategy, “No Health without Mental Health”—we recognise the symbolic significance of including these words in clause 1. Mental health is a priority for this Government, so I commit to considering further the role that the mandate, the NHS and public health outcomes frameworks can play in driving improvements in mental health services. Similarly, we decided not to oppose amendment 54 by the noble Lord Patel of Bradford relating to mental health aftercare services provided under section 117 of the Mental Health Act 1983, and tabled a number of consequential technical amendments.

I am grateful for the scrutiny that the Bill has received in another place. There is no doubt that it has been strengthened and improved as a result. It will help to ensure that the Secretary of State will remain accountable overall for the health service and provide a robust framework for holding commissioners to account. I urge hon. Friends and hon. Members to agree to the Lords amendments in this group, but to reject Opposition amendment (a) to Lords amendment 31.