Health and Social Care Bill
Debate between Simon Hughes and Paul Burstow(12 years, 8 months ago)
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Paul Burstow
The hon. Lady says it is a strange set-up and refers to her endeavours to get an answer to the question. I have not seen details of her exchange with the Secretary of State, but I will look at that and write to her with an answer to the question.
Simon Hughes (Bermondsey and Old Southwark) (LD)
My hon. Friend is dealing with matters of great concern outside this place, and I am clear that all these amendments are a move in the right direction. Will he put it on the record that as a result of the Bill, first, it will not be possible in future for any hospital to move, as Hinchingbrooke did, from the public sector to the private sector, and, secondly, that the proportion of private sector business cannot be increased up to the 49% that has been mentioned and will be increased only if the hospital decides, according to the amendments, to increase it by the small percentage that the amendments now allow?
Paul Burstow
I am grateful to my right hon. Friend for his questions. Let me start with the issue of Hinchingbrooke, which is an important one. It is worth remembering that the vast majority of the process that led to that franchise arrangement was completed under the Labour Government, not by the current Administration, and was part of the arrangements put in place by the Labour Health Act 2006 and Health and Social Care Act 2008. The Bill makes sure that in future there can be no scope for sweetheart deals to incentivise new entrants into the NHS, it ensures that there cannot be price competition of the sort that was allowed under the 2006 Act, and it ensures a protection for commissioners to decide when and if it is appropriate to use competition. That is not a protection that they enjoy under the 2006 or the 2008 Acts.
Simon Hughes
I will give way to my hon. Friend and then to the shadow Secretary of State.
Paul Burstow
I am grateful to my right hon. Friend for setting out these issues again so clearly and for putting to rest the myths that are yet again being fanned by Opposition Members. I confirm that the Bill provides two further safeguards. First, Monitor will continue to have a direct oversight role in this regard. It will be able to intervene and use its licensing powers and other powers to deal with concerns if NHS services are put at risk by the decisions of a foundation trust. Secondly, there are the contractual relationships that commissioners have directly with these organisations.
Simon Hughes
I accept that. That is why the amendments tabled by the right hon. Member for Leigh (Andy Burnham) are not necessary. Monitor already has a control that it can exercise to ensure that what he calls strategic control or central control is retained, as well as local decision making.
I will end this point by saying that although, technically, there could be a vote of the governors of any hospital—in the right hon. Gentleman’s constituency or mine—every year to increase private income by more than 5%, that is not the real world. In the real world, the people of this country love their national health service, NHS staff love their national health service, and the governors of the hospitals that I represent love their national health service. Those people are not suddenly going to change their attitude after 60 years of the NHS.
In the post-war Parliament, when the Labour party, supported by the Liberal party, put through the plans drawn up by Beveridge, the Liberal, for the NHS, it accepted from the beginning that there would be some private sector activity. From the beginning, GPs and some dental services were in the private sector, and they have remained there.
I am clear that the Bill does not mean that there will suddenly be a market, a route or a tramway for privatisation. Others say I am wrong—I know that there is a lot of concern—so I am clear that when the Bill becomes an Act, we need to sit down with the health professionals who still have concerns—[Hon. Members: “Too late.”] No, it is not too late if people understand what is really in the Bill, rather than what some people say is in the Bill. It is not too late if people look at the wording of the legislation, and do not just listen to the arguments about it.
I say to the right hon. Member for Leigh, whom I respect in many ways, that he has often distorted what has happened in the past and what will happen now. He has ignored the facts that Labour forced privatisation on the health service in many parts of England and that Labour paid more to the private sector to carry out activities for the NHS. I am here to support these provisions in the Bill because I want to end the incentives for the private sector and to end the enforced privatisation of the health service. I will ensure that there is no chance of any hospital in my part of the world voting significantly to increase private sector activity, because the NHS wants to remain in the public sector and deserves to be supported by us to do so.
I refuse to be misrepresented by Labour colleagues who accuse us of doing something that we are not doing. We have a public national health service, paid for through our taxes. Everybody has an entitlement to the best care in the country. I will not do anything that undermines that. I hope that the right hon. Member for Leigh will not and that Ministers will not. I agree that we have some work to do to reassure people outside this place. I hope that, from today, the right hon. Gentleman will join me in telling the truth about the Bill and not tell untruths.
Lords amendment 63 agreed to.
Lords amendments 64 to 147 agreed to, with Commons financial privileges waived in respect of Lords amendments 132 to 141.
Clause 161
Goods and Services
Amendment (b) proposed to Lords amendment 148.—(Andy Burnham.)
Question put, That the amendment be made.
Simon Hughes
One thing that has got lost in all the noise about the Bill is the fact that there will be more opportunity for local authorities and local people in England to be engaged. Will my hon. Friend put on record how an ordinary constituent of his in Sutton, mine in Southwark or anywhere else—not a professional such as a GP or a nurse—will be able to get involved? I think there will be a much better system in future than there has been.
Paul Burstow
My right hon. Friend is absolutely right. Hard-wired throughout the Bill are requirements on patient and public involvement in clinical commissioning groups and health and wellbeing boards. Local healthwatch will provide a vehicle for delivering much wider engagement. One criticism that has often been levelled at past attempts at public and patient engagement has been the absence of hard-to-reach groups, which are seldom heard from in our health system. As a result, their voices have not helped to shape commissioning decisions. We need to ensure that they do, so that CCGs commission effectively for their whole population. That is a key part of what the Bill provides for.
As the Bill makes its way on to the statute book, Members of all parties will need to look closely at the opportunities for far wider public involvement that will result from how it has been improved. We have listened closely to groups such as the Richmond group, which has been a powerful advocate on behalf of a wide range of patients’ groups. It has talked about the importance of involving patients far more in co-production and commissioning decisions. That is an essential component of how we intend the Bill to be given effect in the months to come.
In tabling our amendments in the House of Lords, we wanted to ensure that local authorities had greater flexibility in the organisational form that local healthwatch takes. Local authorities are best placed to make decisions about the right way to commission a local healthwatch service for their area, but they cannot decide not to have a local healthwatch organisation, and we would not allow them to do that. It is essential that the voice of patients and carers is heard loud and clear in the decision-making processes of our NHS and social care services.
Simon Hughes
One last time—I am grateful to the Minister. Will he put on the record what constituents all over England can do if, for example, they hear that their hospital might want to close a ward for the mentally ill, or close accident and emergency services, or if it realises that there is no day care for people with mental illness? What power do they have to stop or start something?
Paul Burstow
Just to be absolutely clear, may I say that clinical commissioning groups cannot subcontract decision making about their commissioning functions—that is crucial to the effective delivery of this. On the issue of the local healthwatch organisations, the Bill makes it clear that local healthwatch has to exist in each locality, and that local authorities have to contract for it to exist and to provide the range of services that the Bill provides for it to undertake.
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.
Health and Social Care (Re-committed) Bill
Debate between Simon Hughes and Paul Burstow(13 years, 2 months ago)
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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.
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.
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.