Health and Social Care Bill

Simon Hughes Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

I wish the Government would listen to voices such as the student nurse that my hon. Friend the Member for Sefton Central (Bill Esterson) quoted—people who want to dedicate their lives to the NHS. Frankly, their views are brushed aside by an arrogant Government.

It gets worse as the Bill enters a new crisis, with one of the coalition parties formally withdrawing permission from its peers to support the Bill. It is not at all clear what happens now—whether Lib Dem peers will defy the wishes of their party or their leader. Given the developments of the last few days, it is simply inconceivable that the Government can continue on their current course and present the discredited Bill here in seven days. The only responsible thing to do is listen to what Lib Dem Members are saying and support what the amendment tabled by the hon. Member for St Ives seeks to do. I will deal with that shortly.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Just so that the right hon. Gentleman is clear, the motion that the Liberal Democrats passed on Sunday did not tell the Lords that they should or should not support the Bill. It simply reserved our party members’ judgment until we see the work that the Lords are continuing to do. That is our position. I think that that is sensible and fair for the NHS and our party.

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[Mr Lansley]

That is indeed true, and my hon. Friend will also be aware—the Future Forum was clear about this—that the NHS benefits from the transfer of competition powers. The Bill does not create any new competition powers in the NHS; it transfers the exercise of competition powers from the Office of Fair Trading to Monitor, as a sector-specific regulator, as we agreed in the coalition agreement. That is what the Bill does, and that is a better protection for the NHS compared with what would otherwise be the application of competition rules, and before—[Interruption.] Labour Members mutter, but it has become apparent over recent weeks that in 2006, when the right hon. Member for Leigh was a Health Minister, it was their Government who received legal advice that demonstrated that their changes had introduced the application of EU competition rules into the NHS.

[Simon Hughes]

Will the Health Secretary amplify his answer to our Scottish National party colleague, the hon. Member for Dundee East (Stewart Hosie), and make it quite clear that both Government policy and, now, the construction of the Bill not only prevent private sector activity from going out of the health service in terms of finance, but restrict the method of expanding private sector activity? The controls are now in the Bill, even if they were not at the beginning.

[Mr Lansley]

rose—

Health and Social Care Bill

Simon Hughes Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

At the last election the average waiting time for in-patient treatment was 8.4 weeks. In December 2001, when the most recent data were published, it had come down to 7.7 weeks. The right hon. Gentleman might like to reflect on the fact that the number of people waiting more than a year for treatment in the NHS is now more than half what it was at the last election.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I thank the Secretary of State for accepting many of the amendments to the Bill proposed by our colleagues and others and thank his colleague in the House of Lords for accommodating not only Liberal Democrat and Cross-Bench peers, but Labour peers who have joined us in bringing forward such amendments. Will he give an undertaking to continue to work collaboratively to improve the Bill to the very end and reject Labour’s allegations that it did not force privatisation on the NHS, which we are definitely not doing?

NHS Risk Register

Simon Hughes Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I entirely understand my right hon. Friend. My colleagues and I very much look forward to the conclusions of the Justice Committee’s post-legislative scrutiny of the Freedom of Information Act.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

rose—

[Mr Lansley]

Further advice from my right hon. Friend, not only to me but to the Prime Minister, is always welcome.

[Simon Hughes]

I defend the Government’s record on the openness of information, and I am a clear believer that the Freedom of Information Act, which I and many Liberal Democrats supported, is the right way forward. Will the Secretary of State therefore confirm that the Government are doing nothing other than following the policy provided for in the Act, which is that when there is a dispute, including when the Government and the Information Commissioner have a different view, the matter properly goes to the tribunal, and the Government respond positively to the tribunal’s decision?

[Mr Lansley]

I am grateful to my right hon. Friend, because I had not intended to quote the Information Commissioner, who wrote an article in The Observer in which he rightly states that he is not infallible. The Government have the right to appeal to the tribunal and we have exercised that right. The tribunal is a proper place in which the public interest test can be applied.

Let me return to the reasons why we do not publish high-level risk registers, the first of which is candour. To be effective, a risk register requires all involved—not necessarily the officials responsible for the policy, but others—to be frank and open about the potential risks involved. It is their job to think the unthinkable and to look at worst-case scenarios. It is vital that nothing is done to inhibit the process of identifying risk. If people are in doubt about the confidentiality of their views, they will inevitably think twice before committing themselves to such direct and candid language in future. Without full candour, risk registers across the Government would be bland and anodyne. In effect, they would cease to be of practical value. Inevitably as a consequence, that would lead to a reduction in the quality of advice given to Ministers.

The second reason is that disclosure can increase the likelihood of some risks happening—it is like a self-fulfilling prophesy. When some risks are made public, those potentially affected are likely to act in a way that could increase the likelihood of the risk actually happening. Let us imagine publishing the risk registers of banks—no doubt the shadow Secretary of State would tell us that the risk registers of banks owned by the Government should be published. The consequence of publishing such risks would be to precipitate financial events.

Lord Turnbull, former head of the civil service, and not under this Government, said in another place:

“Managers might be reluctant to be frank in public about operational difficulties if that would undermine their ability to make contingency plans or could trigger an event before their plans are ready.”—[Official Report, House of Lords, 7 December 2011; Vol. 733, c. 729.]

The purpose of a risk register is to secure mitigation of those risks, not to precipitate them.

National Health Service

Simon Hughes Excerpts

Wednesday 26th October 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman is a shadow Treasury Minister, so he must know that the expression “real terms” has consistently been used in relation to the GDP deflator, which is independently estimated by the Office for Budget Responsibility. That is the basis on which we do these calculations, so the Wales Audit Office will have calculated the real-terms changes in budgets in each of the countries of the United Kingdom on that basis. John Appleby from the King’s Fund has estimated an 8.3% real-terms cut in the NHS budget in Labour Wales.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

The Secretary of State is, justifiably, giving a robust performance. He said that his job is to shine a light into the NHS to make sure there is a better service for patients. Can he assure us that the recent findings about the care of the elderly in our hospitals and the recommendations of the Cavendish report on that issue will receive the Department’s full attention, as that is one of the areas where the NHS often fails to fulfil the expectations of patients and their families?

[Mr Lansley]

I agree with my right hon. Friend, and I appreciated the opportunity to talk with Camilla Cavendish and to read much of what she has written.

In January, I asked the Care Quality Commission to undertake dignity and nutrition inspections. They were nurse-led, unannounced inspections across NHS hospitals. The reasons for doing so were clear. I do not say this to denigrate the NHS, but many of us were concerned about two issues. First, although patients admitted to hospitals might get very good clinical care, the standards of personal care were often not as good as they should be, and they were seriously deficient in some cases. Secondly, the last Labour Government had star ratings for hospitals, the net effect of which was as follows. On the Healthcare Commission website, there would be a green dot against a hospital, which was often taken to mean, “This hospital is fine.” However, we all knew that some hospitals had tremendous reputations and world-beating clinical care in some respects and some wards where care was fantastic, but that care in neighbouring wards could be seriously deficient. The dignity and nutrition inspections have addressed that.

The CQC will follow up wherever it has found concerns. In addition, it will undertake similar unannounced inspections of learning disability services and there will be 500 unannounced inspections of care homes, to seek out and expose poor performance or poor care in those areas—and, I hope, demonstrate where good care is provided. There will be an additional follow-up inspection of a further 50 NHS hospitals.

[Simon Hughes]

I am grateful to my right hon. Friend for his comments. May I raise a linked point? One of the issues most frequently raised with me both in my constituency and elsewhere is that families and patients often do not feel that they have consistent contact with just one person who is responsible for the management of the care in a hospital. Instead, there is a range of people whom they do not know, except for what is printed on their name badges. They know the consultant, but they do not know who is responsible on a day-to-day basis for the delivery of 24-hour care. Can my right hon. Friend assure me that that is also on his agenda?

[Mr Lansley]

I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.

Health and Social Care (Re-committed) Bill

Simon Hughes Excerpts

Wednesday 7th September 2011 Commons Chamber

[Martin Horwood (Cheltenham) (LD)]

On a point of order, Mr Speaker.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

rose—

[Nadine Dorries]

I will not give way. The right hon. Gentleman may be interested to know—

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[Paul Burstow]

No, he will not have powers of direction. Of course, powers of direction are not subject to any form of parliamentary scrutiny and can be issued by a Secretary of State by fiat. In future, this House, through regulations, will be able to look at and agree—or not—standing rules that in most effects will have the ability to direct clinical commissioning groups and the NHS commissioning board on a wide range of matters. I direct the hon. Gentleman to clause 17, which sets those out at great length.

[Simon Hughes]

I am listening very carefully and, as my hon. Friend knows, we have had conversations and a wider debate about this issue. I understand what he is saying about the specific power of the Secretary of State both to act and to direct if things are failing, but does he accept that some of us would still like to be persuaded that the best way of enunciating the fundamental duty at the beginning of the legislation is not to say that the principal job is to secure the provision of the services of the NHS but to write in that it is to provide them? The back-stop encompassing statement, as it were, would mean that we could be sure that the duty rested with the office holder of the role of Secretary of State in England at any one time.

[Paul Burstow]

I am grateful to my right hon. Friend for having given me the opportunity to talk about this at some length, and I want to give him some reassurance. However, it is hardly a back-stop to have in clause 1 something that is not what the Secretary of State on a day-to-day basis actually does. It is a back-stop to say that when things fail, the Secretary of State should be able to exercise those functions to make sure that things are put right. I would like to say a bit more about that now.

I want it to be clear that we do not envisage the Secretary of State having to intervene other than in exceptional circumstances. Nevertheless, the measures are the legislative back-stops in the Bill and it is right that they are there to protect the comprehensive nature of our NHS and to provide reassurance. To answer my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) directly, there are a number of ways in which the Secretary of State could secure the provision of services. In particular, he could impose requirements on the NHS commissioning board and clinical commissioning groups using both the mandate and the standing rules. He could establish, and has the powers to do so, a special health authority, and could direct it to carry out any NHS function. That power has been used in the past to establish NHS Direct—a service-providing organisation. Also, he could intervene, including by replacing the management and directing them in the event of a significant failure. Those measures are the belt and braces in the Bill to make absolutely sure that the NHS and the public are protected from all eventualities. We have ensured that the Secretary of State’s powers are sufficient to ensure that a comprehensive NHS is provided, including through the public sector, rather than simply relying on existing providers and the market.

The position is clear: we are giving the NHS more freedoms and autonomy—something that many of us in the House have for many years argued should take place—and we are increasing its accountability. We are making watertight the obligations to provide a comprehensive health service that is free to all, based on need and not ability to pay.

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[Andrew George]

rose—

[Simon Hughes]

rose—

[Paul Burstow]

I will give way to my right hon. Friend the Member for Bermondsey and Old Southwark and then I shall make some progress because this is a very big group of amendments.

[Andrew George]

It is my amendment.

[Simon Hughes]

I am very grateful and I will not keep the Minister long. I have listened very carefully, as colleagues will have done, to my hon. Friend’s extremely reassuring comments. If he and the Secretary of State are committed to working on some wording that will alleviate concerns at the beginning of the Bill, I know that my colleagues and I will be very happy to work with him.

[Paul Burstow]

I am grateful to my right hon. Friend. I can say no more than I have said and I think I have said what is necessary to make the Government’s intentions clear. Of course, I will now give way to my hon. Friend the Member for St Ives, who has been so diligent in tabling so many amendments.

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[Andrew George]

I am grateful to my hon. Friend. He has referred to the issue as being totemic, and although I do not want to detain the House for too long because many others have referred to it, he is absolutely right. Now that it has been raised in such a manner, unless there are good legal reasons not to insert it in the Bill, it should be.

On the comments of the hon. Member for Pontypridd, I make a further point. We are talking about major changes, and the issue is not only totemic but contextual, because, in the context of a major—in fact, the most major—reorganisation of the health service, the reassurance of that backstop being in place would be all the more important.

I do not questions the intentions of the Secretary of State, for whom I have tremendous respect, but, having opposed the creation of the health service in the first place, the Conservatives have a problem, because the context is one of a major change, and whether we like it or not the assumption is that, if the Secretary of State is a Conservative, the hurdle will have to be set higher to reassure the nation that there is no untoward intention behind the legislation.

[Simon Hughes]

My hon. Friend knows that I share his views, and the hon. Member for Stoke-on-Trent North (Joan Walley) made the point that this is both a political and a legal debate. First, there is certainly a political argument for keeping the definition the same as it has been throughout the history of the NHS, which was created in concert by a Liberal and implemented by Labour. Secondly, there is a legal justification for doing so, because there are specific powers to provide, and therefore there is a generic logic in stating that, as part of the initial definition, there is provision for and security of health services. I am therefore sure that my hon. Friend will be on a winning wicket in the end.

[Andrew George]

I hope so, but sporting my cricketing injury I hope that that analogy does not apply.

Health and Social Care (Re-committed) Bill

Simon Hughes Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Burns]

No, because others want to speak.

I can assure the House that FTs will retain their principal legal purpose—to serve the NHS. This means that the majority of their income will continue to come from the NHS. With no shareholders, any profit they make will have to be ploughed back into the FT, and so will support that purpose of caring for NHS patients. The vast majority of FTs have little, if any, potential to increase private income, never mind the desire to do so. For them, NHS activity will remain the overwhelming majority of the work they do, if not all of their work. It is extremely unlikely that even the most entrepreneurial FTs with international reputations would seek to test the boundaries. Their commissioners, public and NHS staff governors would hold them to account in fulfilling their duties and serving their NHS patients.

For these FTs, however, the cap is a blunt instrument that harms NHS patients. FTs tell us that there is potential to bring extra non-NHS income into the NHS, for example, by developing the NHS’s intellectual property, from innovations such as joint ventures and by using NHS knowledge abroad. Additional demand and income can help organisations to bring in leading-edge technology faster, including in the important area of cancer treatment. I hope that that goes some way to helping my hon. Friend the Member for St Ives. Opposition amendment 1165 would harm the NHS, and new clauses 19 and 22 would stop FTs providing private health care altogether. Many of the other protections proposed would be almost as damaging and reduce income.

We want to ensure that safeguards are appropriate, not harmful. For example, a prohibition on FTs offering privately the same services that they offer on the NHS would rule out most of their current private health care. It could even create perverse incentives to stop providing some services for some NHS patients. We are confident that private income benefits NHS patients. On reflection, we are proposing to explore whether and how to amend the Bill to ensure that FTs explain how their non-NHS income is benefiting NHS patients. We will also ensure that governors of FTs can hold boards to account for how they meet their purpose and use that income. I believe that that is an important move forward.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Will the Minister give way?

[Mr Burns]

I hope that the right hon. Gentleman will forgive me, but I will not give way, because other hon. Members wish to speak and the debate finishes in 20 minutes.

To my mind, the private patient cap and the proposed new restrictions are both unnecessary and damaging. Indeed, I know that this will drive some Opposition Members potty, but the former Labour Minister responsible for the cap, Lord Warner, repented his sins in the other place, describing it as

“wrong and detrimental to the NHS.”—[Official Report, House of Lords, 12 May 2009; Vol. 710, c. 936.]

I urge Opposition Members not to repeat that mistake and to heed Lord Warner’s advice. I appreciate that the Opposition Benches are not full of champions of Lord Warner—particularly not at that end of the Chamber from which we heard the earlier comments about him—but he is a respected former Labour Health Minister and I would suggest that he knows what he is talking about.

Let me deal briefly with two final points that were made by the hon. Members for Islington South and Finsbury and for St Ives about the safeguards that are in place to offer protection and ensure that NHS patients would not lose out with the removal of the cap. First, the NHS commissioning board and clinical commissioning groups would be responsible for ensuring that NHS patients are offered prompt and high-quality care, and that good use is made of NHS resources, whoever provides care, through robust contracting arrangements. NHS patients will also maintain their right in the NHS constitution to start treatment within 18 weeks of referral. Secondly, as foundation trusts do not have shareholders and cannot distribute surpluses externally, and as their principal legal purpose will remain to serve the NHS, all proceeds from non-NHS work would be reinvested in the organisation, ultimately adding to the level and quality of the NHS service.

The Bill will make FTs more accountable and transparent to their public and NHS staff. Our commitment that FTs will produce separate accounts for their NHS and NHS private-funded services—as well as Monitor’s use of its regulatory powers to ensure a level playing field between providers—will also help to avoid any risk of NHS resources cross-subsidising private care, thereby protecting NHS money. I believe that those five safeguards will protect NHS patients and the NHS, and will not lead to the situation that the hon. Member for Islington South and Finsbury described in her speech.

Oral Answers to Questions

Simon Hughes Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

The right hon. Gentleman will doubtless be aware that we published a quality standard for ovarian cancer, and that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), published the outcomes strategy for cancer, which will have been relevant to many of the issues to which the right hon. Gentleman refers. I continue to look forward to the results of a major trial on screening for ovarian cancer, but I am afraid that I anticipate that we shall not be able to see the results and recommendations for nearly three years.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

4. How many 24-hour GP services are in operation; and if he will make a statement.

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

We are not aware of any GP practices that offer services on a 24-hour basis.

[Simon Hughes]

Will the Minister confirm that the Government would have no objection, and would not put any barrier in the way, if Guy’s and St Thomas’ NHS Foundation Trust and the local Southwark services wished to set up a 24-hour service at Guy’s hospital, with the collaboration of the local community?

[Mr Burns]

As the right hon. Gentleman will know, the local NHS has responsibility for commissioning local primary care services, and in doing so it must take into account the results of the local population and their needs. If he is working with the hospitals and organisations that he has mentioned and he has some constructive ideas that they are going to consider, I too would be personally interested to hear from him about how they envisage doing things.

NHS Future Forum

Simon Hughes Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

The listening exercise has to date—on 14 June—cost £36,640.97. The process of modernisation in the NHS is saving hundreds of millions of pounds every month. We know that we have to not only increase resources to the NHS but deliver continuously improving productivity and efficiency in the NHS. The Labour party always ignored that and failed on that; we will not fail on that.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Today’s proposals are clearly winning the support of the health professionals and of political colleagues, but to win the support of the public and the patients I hope the Secretary of State will be able to give one further assurance that these plans will give greater local democratic accountability for the NHS than ever before and will therefore mean no enforced local privatisation of services, which happened under the previous Labour Government.

[Mr Lansley]

Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.

Oral Answers to Questions

Simon Hughes Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Burns]

I hope that I can reassure the hon. Lady, because if there were to be any reconfigurations in the future—I put that in the conditional tense because the relevant trust is confident that there will not need to be any—quite clearly the four tests that my right hon. Friend the Secretary of State introduced last May would have to apply. There would have to be full consultation with local people and with clinicians, GPs and others in the health economy.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

3. What processes he has put in place to allow lay members of the public and elected public representatives to contribute to discussions on the reform of the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

Following formal consultation last year, and as I told the House on 4 April, we are taking this opportunity to pause, listen, reflect and improve the Health and Social Care Bill. A total of 119 events have already been organised centrally, and the regional and local NHS will organise many more. Those events will allow us to hear a full range of views from professionals, the public and patients.

[Simon Hughes]

The Health Secretary knows that colleagues welcome the pause and the opportunity to reflect on what changes might be beneficially made to the legislation. Will he assure us that lay people and elected representatives, such as councillors and others, will be fully engaged in the process? The professionals have had their say, and they have very strong views, but the patients and elected people need to have their say, too.

NHS Reorganisation

Simon Hughes Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

This is such a big and fundamental change to the NHS that £140 million is the best guess. Clearly, as the competition role of Monitor increases and the competition legislation it has to deal with becomes stronger, those costs could increase. We simply do not know, because this is a leap in the dark for the NHS.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Having listened to the debate at our party conference on Saturday, the right hon. Gentleman will know that there were strong views that the Bill needed to be further improved and strengthened, but he will also know that there was no call for it to be pulled or paused. He will also remember that when his party and my party joined together to form the NHS, the doctors were not always on the side of the enlightened.

[John Healey]

The Liberal Democrats are quick to try to claim credit for other people’s successes, and quick to try to duck responsibility for some of the difficult challenges they face. However, the right hon. Gentleman is right—it was the BMA that called yesterday for the Bill to be withdrawn. Our motion calls not for it to be withdrawn but for a pause in its passage through Parliament to give the Government a chance to rethink, exactly as was requested by speaker after speaker at his conference in Sheffield on Saturday, and all but a handful of the members who voted at it.

--- Later in debate ---

[Mr Lansley]

No.

The fact is terribly clear that before the election the Labour Government said that in three years the NHS would have to save between £15 billion and £20 billion. The Labour party never said in government that that money, if saved in the NHS, would be reinvested in the NHS. The other point is that when we came to the spending review, in which we agreed £10.7 billion extra for the NHS over the life of this Parliament, the shadow Secretary of State’s friends, who were then responsible, said that we should cut the NHS. We do not need to speculate about what they said they would do, because we can look at the example of Wales. The Labour-led Welsh Assembly Government are proposing to cut the NHS budget in Wales by 5%, while we are increasing it. We know exactly what Labour would do if they were in charge of the NHS: they would cut it. We have not cut it and are going to protect it.

[Simon Hughes]

I share absolutely my right hon. Friend’s view that the protection of the budget and the commitment to the principles of the NHS, which he has just enunciated, are really valuable and that Labour’s record in forcing privatisation undermines its whole argument. He knows that there are concerns. Having come back from the debate in my party, I ask him straightforwardly whether he will take on board the concerns expressed and look at ways to strengthen and further improve the Bill as it passes though this House and the House of Lords.

[Mr Lansley]

My right hon. Friend was busy in Sheffield over the weekend, but he might have heard me say on Sunday that where there are legitimate concerns, founded in reality rather than myth, about how we will secure the NHS and its modernisation for the future, we will listen. We have listened and changed the policy before the Bill was introduced. We have already amended the Bill during the course of its passage so far and will always look to clarify and improve it as it proceeds.