Care Bill [Lords]

Simon Burns Excerpts

Tuesday 11th March 2014 Commons Chamber

[John McDonnell]

I will send the hon. Gentleman a few books about council socialism and the socialism of the grass roots.

Today’s debate is about trust, about listening to local people, and about not allowing any further powers to accrete in the Secretary of State’s hands and override local wishes. People do not trust central Government. That is not a party-political point; I think that people have been ill used over a long period by not being listened to at local level, which is why I urge Members to support the new clauses and the amendment.

Let us not denigrate organisations such as 38 Degrees which are merely expressing a view. Others may not agree with that view, but it has been expressed to me not just by 38 Degrees, but in e-mail after e-mail and letter after letter from people whose views I respect because they have gone through the same local experience as me. All that those people want is long-term stability and investment in a publicly funded and democratically accountable health service.

[Mr Simon Burns (Chelmsford) (Con)]

It is a pleasure to follow the hon. Member for Hayes and Harlington (John McDonnell). He said at the beginning of his remarks, and he kept to his pledge, that he was going to speak without party rancour. I, too, would like to do that because I think there is very little difference between my views on the health service and those of the right hon. Member for Leigh (Andy Burnham). We may perhaps have a divergence of view on how to achieve what we both passionately believe in, as does my right hon. Friend the Secretary of State, which is the finest health service for the provision of care for all people in this country, but on the core principle of a national health service, free at the point of use for all those eligible to use it, there is not one iota of difference, despite the speech I heard from the endearing hon. Member for Easington (Grahame M. Morris). I almost felt I had woken up from a nightmare. Having listened to the same speech in 39 of the 40 sittings of the Health and Social Care Bill Committee, I regarded it as my good fortune that during the 40th sitting, my right hon. Friend the then Secretary of State was giving evidence to the Health Committee which prevented the hon. Gentleman being in our Committee.

The point I want to make is this: the national health service has from day one constantly evolved in the delivery of health care, partly because of changing medical science, partly because of changes in the diseases that people have suffered from owing to improved and enhanced preventive care, and partly because many conditions that in the past one would stay in hospital for no longer need to be treated in hospital but can be treated in a GP surgery or elsewhere. We all—politicians, medical practitioners and others—have to recognise that the NHS is constantly evolving and revolving, and we have to adjust to those changes and meet those challenges.

I passionately believe that decisions within the NHS should be taken locally. I supported the Health and Social Care Bill so strongly because it devolved powers and decision making to the people who I think are best qualified to take commissioning decisions on behalf of patients—local GPs. I also welcome the fact that my right hon. Friend the Secretary of State is no longer micro-managing the running of the NHS on a day-to-day basis. However much admiration I have for my right hon. Friend, or even for the shadow Secretary of State when he was in post, I do not think he is best qualified to be running the health service on a day-to-day basis.

If we are going to evolve and meet the challenges, difficult decisions will have to be taken, and politicians in particular—politicians of all political parties; this does not apply simply to Opposition Members of Parliament or to Conservative Members or to Liberal Democrats—have got to be braver. When there is any consideration of a reconfiguration to meet new challenges or address problems, the knee-jerk reaction is to take the populist, easy route, say no and oppose for opposition’s sake, rather than look at the reasons behind any reconfiguration.

[Andy Burnham]

The right hon. Gentleman knows I have huge regard for him and I do not disagree that change needs to be made. The question, however, is how we make that change. I remember that when the earlier Bill was going through, he repeatedly said in this House and in TV studios that the principle behind it—if it had a principle—was to put local doctors in charge. Does he think that clause 119 is consistent with the argument he made when the earlier Bill went through?

[Mr Burns]

I am grateful to my right hon.—or, rather, the right hon. Gentleman; I nearly made a Freudian slip—for that question. I can unequivocally say to him that I believe it as strongly and firmly today as I did when I was one of the Ministers taking the Health and Social Care Bill through this House three years ago. And I shall tell the right hon. Gentleman why I believe it.

I was saying that politicians of all parties must strengthen their backbone and be prepared to look at each case of reconfiguration on its merits, and then take difficult decisions if they are in the best interests of patients. I believe that reconfigurations should initially be determined at local level—[Interruption.] If the right hon. Member for Leigh will wait, I will get to his point. They should be determined by local commissioners in consultation with local people and with the health and wellbeing boards, which play a vital part in keeping local communities and local health interests plugged in and represented, and in ensuring the delivery of the necessary services locally.

However—this is where I get to the right hon. Gentleman’s point—there will be a few rare and exceptional circumstances in which a TSA will have to be appointed. That is what happened in the case of South London. At that time, I happened to be privy to all the discussions that led up to what was, if I remember correctly, the unprecedented decision taken by the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).

[Mr Dorrell]

My right hon. Friend is making the key point in this debate. He is describing a locally rooted, clinically led consultation process that engages the professional community as well as the local political community. It must be right that we deliver change in the health and care system in that way. The Health and Social Care Act was motivated by exactly that thought process, as my hon. Friend the Member for Wycombe (Steve Baker) said. That is not what clause 119 is about, however. It covers how we should deal with the very confined circumstances in which all those processes have failed. Are we really going to say that a trust special administrator can only look at the circumstances of an institution that has been proved to be unviable? Or are we going to allow him to look outside those circumstances, in order to deliver better care for patients? That is the question the House has to decide on this evening.

[Mr Burns]

As always, my right hon. Friend anticipates what I am about to say and says it in a far more straightforward way. He is absolutely right to say that there will be exceptional circumstances; there has been one instance so far. In such circumstances, the health economy in a particular area will need to be looked at—not in isolation; that is impossible owing to the nature of patient flows and the delivery of care—in order to get to the bottom of the problem and solve it on the ground.

A number of hon. Members said that clause 119 was a vehicle for closing down hospitals or services while totally disregarding the wishes and needs of the local health economy and local people. I say to them with the greatest respect that they have—probably for genuine reasons—misunderstood the purpose of the TSA. I ask them to think again, because this is too important an issue to be politicised and used in a game of ping-pong between political parties, or groups within those parties, to try to score political points. Our sole aim must be to ensure the improvement and viability of services. Sometimes, tough decisions will have to be taken—because of changing patterns, or whatever—and in the overwhelming majority of cases, they will be taken through consultation and through the decision-making process in the local health economy.

We have been talking about the power of the TSA. I must point out, in the friendliest and gentlest way, that that power was not introduced into the health service by this Government. It was done, I think I am right in saying, by the right hon. Member for Leigh’s predecessor, and he did it for very good reasons. He accepted, as my right hon. Friend the Member for Charnwood (Mr Dorrell), the Chair of the Select Committee, said in his intervention, that there will be rare occasions when everything else has failed and this measure of last resort must be used. It is viable and reasonable to have that power as a measure of last resort, as the previous Government obviously thought; otherwise, they would never have put it on the statute book in their legislation.

[Mr Jamie Reed]

When this was tested in the High Court, the judge said that the Government were seeking to use the powers that the right hon. Gentleman has just described for a “strained and unnatural” purpose. Does he agree with that?

[Mr Burns]

The short answer to the hon. Gentleman, because I have the freedom of the Back Benches, is that I do not share that view. I was privy to the discussions that led to South London being put into special measures. That was done because there were real and significant problems to which it was impossible at a local level, within NHS London and elsewhere, to find a coherent—[Interruption.] The right hon. Member for Leigh says no. He was in opposition at the time these conversations were taking place.

[Andy Burnham]

It is wrong. The right hon. Gentleman will know that when he arrived at the Department of Health in May 2010, there was a plan in place called “A Picture of Health”—[Interruption.] My hon. Friend the Member for Lewisham West and Penge (Jim Dowd) agrees. The plan, which had been extensively debated and consulted on at local level, was to make difficult changes to the health service in south-east London. That plan was shelved because of the right hon. Gentleman’s moratorium, and precious time to make changes was therefore lost. The financial problems in those health service organisations increased because the plan was shelved, and they were left with the option of having to bring forward a more brutal administration process. Please do not rewrite history in a debate as important as this.

[Mr Burns]

I agree with the right hon. Gentleman that this is a very important debate. I have the benefit of having attended the meetings and having seen what was happening in South London. In one respect the right hon. Gentleman is absolutely right: there was a moratorium. The country wanted a moratorium to start with because of some of the closures that were causing problems, and people wanted a re-examination of the situation to check that the right decisions were being taken. Work was still going on to find a solution to South London, and my right hon. Friend the Member for South Cambridgeshire reluctantly came to the conclusion that he had to take the exceptional power that was available to him.

[Jim Dowd]

Will the right hon. Gentleman give way?

[Mr Burns]

No. I am about to conclude as I know the winding-up speeches have to begin.

In conclusion, this is an important power, and it is there to be used in very exceptional circumstances. It is factually incorrect and it will scare people to accuse any Government of using the power to reconfigure services. It will not be used for that. Reconfiguration will go through the correct processes and be based locally, with the local health economy and local people and with the input of organisations such as the health and wellbeing board. It would be foolish, as I think the previous Government agreed, not to have an emergency fall-back position to secure that. That is why we had the original power under Labour’s legislation, and my right hon. Friend the Secretary of State is continuing that power and fine-tuning it.

[Dr Poulter]

I thank all my hon. Friends and other hon. Members for their contributions to this important debate. I shall respond to as much of what has been said as I can in the time available.

The House is being asked to consider specific changes the Government are making to the existing trust special administrator regime, which was introduced under the previous Government. I stress at the outset that the TSA regime will not be used routinely, and will only be used when all other processes at a local level to deal with the challenges of hospitals have been exhausted. The usual approach for locally led reconfigurations will remain. TSAs are for rare and extreme cases of failure. This is not a power to be used to reconfigure services routinely—we need to get that right at the outset. This is a system of last resort, and other actions will of course be taken first to address the problems of trusts in difficulty.