Health and Social Care Bill
Debate between Simon Hughes and Andy Burnham(12 years, 9 months ago)
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Andy Burnham
It is important to begin by setting out the background to many of the amendments in this group. Despite the pause that the Government ordered for the Bill, they failed to allay fears about the creation of a market based on a 1980s utility privatisation, with Monitor acting as an economic regulator—a parallel drawn last November not by me, but by the King’s Fund in a report it published. That, more than anything else, has been behind the huge professional disquiet about the Bill that we have seen over recent weeks and months, with respected professional organisations coming out one after another to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, doctor against doctor. That is where we start.
The Minister began his remarks by talking about the myths relating to part 3 of the Bill and objecting to some of the interpretation that I have just given. I do not know who he had in mind when talking about those myths, but it might have been the noble Baroness Williams. I will quote from an article she wrote in The Guardian on Monday 13 February. It is important because it explains the genesis of one of the amendments that the House is considering tonight. She acknowledged that there were:
“fears among the public and within the medical profession that clinical commissioning groups might become dependent on advice from powerful private health companies, and that the imposition of UK and European competition laws, addressed to markets and not to social goals, might destroy the public service principles of the NHS. In plain terms, this is often described as a fear of privatisation. These are issues that must be addressed.”
When the Minister talked disparagingly about myths, did he have the noble Baroness in mind? I think that he must have done, because in the same article she went on to suggest that the answer to the concerns and fears that she had correctly identified was to drop the whole of part 3. She wrote:
“What that would mean for the bill would be dropping the chapter on competition, and retaining Monitor as the regulator of prices and of the foundation trusts.”
I am not privy to the internal machinations of the Liberal Democrats, but I think that there must have been some wrangling and soul searching in the two weeks following the publication of that article, because by 27 February a letter had emerged that was co-signed by the noble Baroness and no less a figure than her party leader, the Deputy Prime Minister. The call to drop part 3 of the Bill, which had been made so eloquently in The Guardian two weeks earlier, had in fact turned into something very different. The letter stated that they needed to go further to amend the Bill in order
“to rule out beyond doubt any threat of a US-style market”.
If what the Minister has said at the Dispatch Box this evening is true and all these fears are myths, why did his party leader and the noble Baroness send that letter? Indeed, why were there even concerns about the threat of a US-style market, which his party leader acknowledged on 27 February? They do not sound like myths to me; it sounds like they were very real threats indeed.
What I want to address this evening is the fact that when the package of amendments that were meant to put the Clegg-Williams package into the Bill finally emerged, they fell considerably short of what was promised in the letter. Indeed, we are dealing with some of those tonight. I will focus on Lords amendment 148 in particular, which deals with the private patient income cap. When the Minister spoke a moment ago, I did not find him reassuring at all. When he spoke about foundation trusts in the future he said that they would of course remain the principal providers of NHS services, but I do not find that at all reassuring. The exchange he had with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) was very revealing. The right hon. Gentleman made a mistake that the noble Baroness made when she took on Polly Toynbee on the same issue. The right hon. Gentleman, like the noble Baroness, does not seem to understand the effect of the amendments he is agreeing to. He began by asking, “Wasn’t it the case that the 49% figure was now completely ruled out and wasn’t relevant?” No is the answer to that. All that the Minister has offered him is that if the increase is more than 5%, it then has to be passed by a vote. I find it incredible that a Member of his years and standing in this House has just revealed that he does not understand the amendments that have been signed up to in order to deliver the package set out in the Clegg-Williams letter. That is a terrifying state of affairs; I do not know what the Members in his party who voted against that might make of it.
Simon Hughes
I absolutely understand the amendment, as I am sure does the right hon. Gentleman. Given that 1%, 2% or 3% of most hospitals’ activity is private at the moment, as he well knows, it seems to me that it is a much better guarantee that we have a rule that says that no hospital can increase that by more than 5% of what it is now unless there is a decision made locally. That gives much more security than anything else previously in the Bill, and that is why it seems to me to be a very worthwhile amendment.
Andy Burnham
Let me answer that directly. The Financial Times has analysed the latest data on actual NHS income earned through the treatment of private patients and demonstrated that in the last year not a single hospital trust would have been caught by this so-called safeguarding amendment. It used the example of Great Ormond Street, which increased its income from private patients by 19% from 2009-10 to 2010-11, to £25 million. In percentage points, that increase was less than 1%. Given the small numbers in the cap which the right hon. Gentleman has just mentioned, he is agreeing to trusts being able to increase their income from private patients by multiples of hundreds of percentage points without any reference to their boards of trustees. Frankly, he has not addressed the point that he has failed to understand that the Bill still gives trusts the permission to increase it to 49%. They could go to the trustees and increase it to 49%. He might be reassured by that, but I most certainly am not.
Andy Burnham
The amendment gives us no protection at all, and it gives us no protection from the NHS cross-subsidising private care. There is nothing in the Bill which says, “The whole costs of the provision of that care have to be reimbursed to the national health service”, as the Financial Times has again demonstrated, and that is why we object to what is happening. We are going back to the old days of the NHS, whereby patients are told, “You can go private or you can go to the back of the queue and wait longer.” That is the choice which we removed from the NHS during our 13 years in government, and we will not accept any return of it.
Simon Hughes
I do not think that I have any more support or encouragement for the private sector in the NHS than the right hon. Gentleman does. May I therefore get him to accept that what Lords amendment 148 does is to limit in relation to each hospital an increase to—
Simon Hughes
No, to 5% of its current figure—not 5% in total, but a 5% proportion. That is what the amendment says, and that gives Guy’s hospital, St Thomas’s hospital and King’s College hospital and patients the reassurance that I think they need. The right hon. Gentleman should read the amendment.
Andy Burnham
I am not going to debate that now. The right hon. Gentleman is going to have to defend himself on whether he has his facts right. I do not think that he has.
We need to put firmly on the record that there are real flaws in the Liberal Democrats’ proposal. They say that it is a safeguard to state, “The governors will decide and it is better done at a local level,” but the governors are going to be under pressure from the management of the hospital because of the pressure on the hospital’s finances. If they make a decision that is in the interests of that hospital, it does not mean that it is in the interests of everybody and of NHS patients.
Simon Hughes
I am absolutely clear that I was not sent to this place to force through the privatisation of the NHS, to force people from the public sector into the private sector, or to undermine great hospitals such as Guy’s, St Thomas’s and King’s College or the other hospitals in my constituency and my borough. Like colleagues from all parts of the House, I know what a fantastic service the NHS provides, not as a matter of policy but from personal experience. It saved the life of my younger brother and looked after my mother in her last days in the most fantastic way that anybody could wish for. I am clear about the commitment of the NHS.
I am therefore clear that we have to look at what the Bill says and what it will do. I have had an exchange about that with the shadow Secretary of State for Health. This is a really important issue outside this place. Clause 161 sets out the following principle:
“The principal purpose of an NHS foundation trust is the provision of goods and services for the purposes of the health service in England.”
That was not thought to be enough, so colleagues in the other place said, “Let’s for the first time ever make it clear that private activity can never be more than a minority activity.” That is why the 49% figure appeared.
However, that is not still enough—[Interruption.] Let me deal with this point. That is why Lords amendment 148 is before us. It states that if any foundation trust hospital in England proposes to increase its private income by 5% or more from its current level, which is usually about 2% or 3% of its income, the governors have to agree to the proposal by a majority. There will not be any great vote by the governors of Guy’s and St Thomas’s, King’s College or any other hospital, with the public participation in the debate that there would be, suddenly to increase their private sector activity. That is not the real world, because that is not what the British public want. There are one or two cases—
Simon Hughes
In a second. There are one or two cases, such as the Royal Marsden, which have historically had a higher percentage of private sector activity. Those hospitals have justified doing so, because they are specialist hospitals that have got money in from outside. However, I do not want us to leave this debate letting the public believe that there will now be the opportunity for all the hospitals in England suddenly to move, without any control, towards undertaking huge amounts of private sector activity.
Simon Hughes
I absolutely understand both those points. I understand that commissioning groups cannot subcontract their decisions, but the point I am making to my hon. Friend and to other Ministers is that we have to ensure that the groups do not end up in the position where, although they retain the decision, they leave lots of the thinking about it to the people they employ to do the work. The decisions have to be made by the health professionals. In reply to the Labour amendment, the Minister rightly said that it is a safeguard that local authorities will have the decision on the local healthwatch. Where a local authority is concerned that it should remain in a particular format, it will be able to do so.
In conclusion, I am clear, as I have said to Labour’s Front-Bench team, to constituents and to my friends on the ministerial team, that our constituents still have a huge amount of concern about this Bill; I am clear that a lot of it has arisen because of misinformation and misrepresentation; and I am clear that this is not a privatisation Bill and not a “carve up the NHS” Bill. However, everyone, including Government Members, will need to continue to be vigilant and to continue to talk to the health professionals. I hope that the Government and the health professionals will start talking again very soon. We will also all need to make sure that we understand their concerns and pass them on. I know what my constituents want at the end of this debate; they do not actually want lots of conversations about structures of the health service.
Andy Burnham
I listened to what the right hon. Gentleman said about misrepresentation and I wonder who he had in mind. Did he have in mind the members of his own party who went to Gateshead and asked for the Lords not to support the Third Reading of the Bill, although they did so yesterday? Did he have in mind those people who raised the most serious concerns about this Bill? I am talking about his own party members, who overturned his party’s leadership. I will not sit here and have him suggest that the concerns exist only among those on this Front Bench, because that is not the case; they exist throughout the country, and he needs to acknowledge that.
Simon Hughes
Let me deal with both those points. I acknowledge that absolutely. On past occasions, the right hon. Gentleman has been to our party conference, although I do not think he came to the Gateshead conference. [Interruption.] It appears that one of his colleagues did. There were and are concerns in my party about this. My party wrote the plan for the NHS, which the good Labour post-war Government implemented, so of course we think we are as much the proprietors of the NHS as his party and of course there are concerns. There are many concerns—many colleagues are not happy with the Bill—and I am owning up to that.
I am absolutely clear about that, but do not let the right hon. Gentleman misrepresent what happened at Gateshead. My party is a democratic party. It is more democratic than his, thank God, and much more democratic than the Tory party. Our party voted to commend the Lords for the work they had done, but to suspend judgment on the Bill. My party neither voted to say that the Bill should not go ahead, nor to decide that the Bill should go ahead. That was what the debate, in the end, was about. There was not quite a majority saying, “Stop the Bill”; that was not the view of the conference, although there are many people in our party, as there are in his—this view is also shared by some in the Tory party and elsewhere—who would want the Bill to be stopped.
The Bill is not going to be stopped; it will become law. The Bill contains many good things. My concern now is to reflect what constituents, both health professionals and those who are not health professionals, come to talk to me about. They feel that there is a need to get back to concentrating on the things that really matter, such as making sure the wards are clean; making sure that the staff are of the highest quality; making sure that the waiting times go down; making sure that we can get decent care for the mentally ill; and making sure that our NHS is able to do better on all that it does. That is what the concerns are.
I want to make sure that Ministers understand that once the Bill is on the statute book there should be no cause for rejoicing, because this is not a matter for rejoicing. It is a matter of a challenge for Government to go back in humility to the health professionals and say, “We may not have got it all right—we may have got some of it wrong—but we are willing to listen, to learn and to work with you.” In the end it is collaboration between local authorities, local councillors, local people, Ministers, parliamentarians and those millions of fantastic people who work in the national health service who will make sure that the health service survives. It will survive and prosper in this country as a public health service—thank God—and we must all work together to respond to concerns, alleviate fears and not fan the flames. We must make sure that from now on we work on the basis of facts, not fiction, and that we work with those who have the concern, like we do, that the NHS should survive and prosper.
Health and Social Care Bill
Debate between Simon Hughes and Andy Burnham(12 years, 9 months ago)
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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.
Careers Service (Young People)
Debate between Simon Hughes and Andy Burnham(13 years, 3 months ago)
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Andy Burnham
My hon. Friend makes an excellent contribution; she puts her finger on the problem. I hear anecdotally that, increasingly, schools are saying to young people, “Can you sort out your own work experience? Is someone in the family able to give you an opportunity?” I understand why they might say that because there are lots of pressures on schools, but that highlights the dangers of what is being created. If we live in a world where people say, “The schools do it; we’ll leave it up to them”, that can reinforce low expectations. It is basically telling kids that they cannot break out from their family circumstances because they will dictate what they have experience of and where they will set their expectations. That is what is so wrong about that approach—this random laissez-faire approach to this crucial issue.
My hon. Friend and other Opposition Members will remember a report by Alan Milburn on fair access to the professions during the last Parliament. He made the point that we need to do the reverse—take those young people who have no connection with the powerful worlds of the professions and transplant them into those worlds. We need the highest quality careers advice and work experience for those young people. As the Opposition develop our policy, that is exactly what we should aspire to deliver—alongside excellent careers advice, of course, which has to be impartial, independent and personalised.
Andy Burnham
I agree, just as I did with the Education Committee report, with much of what the right hon. Member for Bermondsey and Old Southwark said in his report. I look forward to hearing what he has to say and to his support for our motion.
Simon Hughes
May I absolutely endorse the comments of the hon. Member for Bristol East (Kerry McCarthy)? All the evidence from my conversations around England in the early part of this year showed that there was not only very poor careers advice for many young people, but really poor work experience. In a difficult economy, the chances of getting a job from 16 onwards are, to put it bluntly, reduced horribly for those who do not have work experience.
Andy Burnham
I agree completely, but the right hon. Gentleman is in a position to do something. I say that not to make a party political point. In some ways, this is not the most headline-grabbing of debates. We are raising this issue out of a genuine concern about what is happening to the careers service and what it might do to damage the life chances of some young people. He has produced what I consider to be a very good report for the Prime Minister and the Deputy Prime Minister, but if Government Members troop through the Lobby against this motion tonight, where does that leave the advice he is giving to the Government? Is he happy about that? There has to be a change.
Simon Hughes
I will obviously wait to hear the Minister and I hope to be called to speak. My hon. Friend the Member for Burnley (Gordon Birtwistle) said to me earlier that this is exactly the sort of issue where we should avoid party politics and seek a consensus. I commit myself again, as I have said to the right hon. Gentleman and to ministerial colleagues, to doing so, even if it is sometimes very hard work to get us all in the same place. Careers, work and work experience seem to me to be issues on which there is much more than a party interest in getting to that right place.
Andy Burnham
I agree very much with the right hon. Gentleman, and I welcome the spirit in which he is speaking. He would probably agree with Labour Members that, as my hon. Friend the Member for Nottingham South (Lilian Greenwood) said, work experience is so important that it should not be left to random chance. We have to find a way of offering structured opportunities, particularly to those young people who have the least. With that in mind, may I ask the right hon. Gentleman to comment on the Government’s intention of removing the requirement on schools, at key stage 4, to offer work-related learning, which essentially is work experience? Is it not the case that if they remove that requirement, provision will be completely random? Some schools will offer it, and some will not.
Simon Hughes
Let me be absolutely straight with the right hon. Gentleman: I understand the Government’s wish not to burden heads and schools with over-prescription. I am chair of governors of a primary school, and a trustee of a secondary school, so I understand that completely. However, some things have to be guaranteed, and in my view we have to guarantee the opportunity of work experience during secondary school time, and we have to guarantee face-to-face careers advice. I say that not because I have some theological view about it, but because the evidence that we have heard, and that I collected, is that youngsters are overwhelmingly saying, “We’ve had bad careers advice and bad work experience.”
In a tight economic situation, people even more need both careers advice and work experience. The figures that I collected show that there are more than 4,000 different qualifications that a young person can gain between the ages of 14 and 18. There are millions of combinations of qualifications that they can end up with. Navigating a way through that requires more than a person’s ability to go online and discover what they think they might want to know; that, bluntly, is different depending on how bright the person is, what family support they have, and other things. It is about more than having some books to look at; it is about speaking to somebody who can relate to them where they are, and engage with them.
As my hon. Friend the Member for Burnley (Gordon Birtwistle) said to me when the debate began, in the end what is required may be more than one half-hour session; there may need to be follow-up—mentoring, support, and continuous commitment. That might mean a local employer—PricewaterhouseCoopers could step over the river to my constituency—coming into a school to continue to support somebody as they work things out. It might mean working out how somebody who fluffs some exams, and does not start very well academically, can recover and be told, “You haven’t lost everything just because you had a terrible year when your parents separated and your family situation was a disaster.” We have to understand that people have only one school time in which they can do work experience.
Education Maintenance Allowance
Debate between Simon Hughes and Andy Burnham(13 years, 11 months ago)
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Andy Burnham
My hon. Friend is exactly right—that is borne out by the experience of many colleges around the country. Some of those young people are at risk of ending up in the benefits system. Will not the Secretary of State’s policy lead to an increase in 16 to 17-year-olds seeking to claim jobseeker’s allowance in exceptional circumstances, or certainly to an increase in the numbers claiming JSA at 18? We know that every young person not in education, employment or training costs more than £55,000, according to research for the Audit Commission. The IFS has said that EMA successfully reduced the number of NEETs. Will it not therefore cost more to get rid of EMA?
Those costs will add up on many levels. As Paul Gregg at Bristol university has found, youth unemployment imposes a “wage scar” that can last for decades. He suggests that scrapping EMA fails to take account of other benefits, such as lower crime. That adds to the fears that through a combination of the Government’s policies, they are taking hope away from a whole generation.
I have set out the education case, the social mobility case and the economic case for keeping EMA, so let us now deal with the democratic case. The Prime Minister and the Secretary of State made personal promises to young people to keep EMA. Failing to honour them will do great damage to young people’s trust in Parliament and politics. From this Dispatch Box, the Secretary of State said:
“We are entirely in favour not only of the existence of the EMA but of the provisions in the Bill to secure an extension to it.”—[Official Report, 14 January 2008; Vol. 470, c. 669.]
Weeks before the general election, he said:
“Ed Balls keeps saying we are committed to scrapping the EMA. I have never said this. We won’t.”
On the back of these statements, does the Secretary of State not accept that young people embarking on a two-year course in September 2010 had a reasonable expectation that they would receive EMA support for the duration of their course, and that they could not have expected that the rug might be pulled from under them?
Beyond that, do the Government have a democratic mandate for this change? This time it is not the yellow Tories, but the real Tories who have broken their promises to young people. However, did any of the people who voted Lib Dem in May vote to curtail the life chances of the least well-off in this way? Unsurprisingly, the Government’s amendment shifts the ground on to deficit reduction, but if that is now the Government’s main argument why did the schools Minister, the hon. Member for Bognor Regis and Littlehampton, say to the House in a holding answer dated 7 June:
“The Government are committed to retaining the education maintenance allowance”?—[Official Report, 14 June 2010; Vol. 511, c. 307W.]
What changed after June? Did the full costs of the risky, unwanted reorganisation of the NHS become known, or did the Prime Minister choose his marriage tax break—costed before the election at £550 million, which is almost the same amount as EMA—as a priority above EMA? This confirms the growing impression that this is a shambolic ministerial team that changes its argument and does not know what it is doing.
The House may be forgiven for feeling a certain sense of déjà vu. This is a rushed decision with no warning, no consultation with those most affected, no evidence to support the decision, a growing backlash as the implications sink in, and a desperate rearguard action to justify it with dodgy statistics. If this is starting to sound familiar, it is because we have been here before with, for instance, Building Schools for the Future, school sport partnerships, and Bookstart. The fingerprints of this repeat offender are all over the scene of the crime. My question today to Liberal Democrat Members is this: how much longer are they prepared to carry the can in their constituencies for the disastrous decisions of this Secretary of State?
Simon Hughes (Bermondsey and Old Southwark) (LD)
The right hon. Gentleman knows that I respect both his passion and his commitment on this issue, and he also knows that there is concern on both sides of the House about the policy to get rid of EMA without an adequate replacement. I repeat now what I have said privately, however: I will work with him, as I am working with the Secretary of State, to make sure, as far as I can, that the successor scheme achieves the objectives that are expressed in both the Opposition motion and the Government amendment. If together we can do that, then together we will improve the reputation of this House and politics in this country.
Andy Burnham
I respect the right hon. Gentleman’s intentions on this issue, but what he has just said will not be good enough for young people listening to this debate whose lives will be directly affected by the loss of EMA. A vague promise to work with the Secretary of State, with an unspecified amount of money to produce an unspecified result, is not going to do the job for them. The Lib Dems have to decide whether they want to keep the benefits of this successful scheme. Do they want the same numbers of young people in their constituencies to enter further education, or are they prepared to take a risk on this Secretary of State and this Tory-led Government?
Today’s debate provides the House with an opportunity to change the message that this Government are sending out to young people. They feel bewildered and angry that they have been singled out to bear the brunt of deficit reduction, and do not understand why they in particular are to face higher costs than generations before. In Newham, they ask why they are paying with their life chances for the mistakes of others a few miles away in the City of London. In Leigh, they cannot understand why the Government want to turn the clock back to an education system based on social class, with places at university going only to those with money and connections. Today, we can show that we are listening to them. We can make a stand for equality of opportunity in education, and stop these moves towards a more elitist education system. We can call a halt to this all-out attack on the aspirations of those who have least, and keep hope alive for the hundreds of thousands of young people who will be cut adrift if the Government get their way. We can tell all young people that we value them, and stop a Government who are gambling with their life chances. I commend this motion to the House.