NHS Reorganisation

Stephen Dorrell Excerpts

Wednesday 16th March 2011 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

I serve on the Select Committee on Health with the hon. Member for West Lancashire (Rosie Cooper), which I enjoy doing. If I may say so, her speech was uncharacteristically partisan, but I guess that that is the nature of debate on the Floor of the House.

The motion moved by the right hon. Member for Wentworth and Dearne (John Healey), the shadow Health Secretary, has a clear, simple message: “Frank was right.” For 20 years, every Health Secretary—starting with my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and including me and my right hon. Friend the current Health Secretary—with the exception only of the right hon. Member for Holborn and St Pancras (Frank Dobson), has espoused the principles that underlie the Health and Social Care Bill.

The motion is an apologia from the Labour party to the right hon. Member for Holborn and St Pancras, for whom I feel rather sorry. He was roundly rubbished by his party in opposition, and now he is being canonised. As in the Roman Catholic Church, it is better that you are dead if you are to be a saint in the Labour party. I did not agree with him when he was in office, and nor do I agree with him now.

As my right hon. Friend the Secretary of State said, the truth is that the principles in the Bill are principles that every Labour Health Secretary, with the exception of the right hon. Gentleman, sought to carry out in office. Let us go through them. GP-led commissioning was one of the first principles that Labour espoused in 1997. My right hon. Friend rightly refers to practice-based commissioning, but that was actually the previous Government’s second attempt to introduce GP-led commissioning, which happened after the first attempt—primary care groups—had failed. The previous Government tried twice to apply the principle that they espoused; my right hon. Friend is trying once again.

[Tom Blenkinsop]

The Bill gives primacy to Monitor, which makes economic decisions. It does not give primacy to quality under the Care Quality Commission. Primacy will go to Monitor, which will make economic decisions on what health treatment people receive.

[Mr Dorrell]

I understand the point, and it is part of the argument that the Labour party has started to make about how, since Christmas, it has suddenly discovered that the Health and Social Care Bill and the policy that it implements—a policy based on commissioners having choices in the interests of taxpayers and patients—require commissioners to have those very choices if the policy is to be effective. As my right hon. Friend the Secretary of State said, the principle of competition for commissioners’ budgets, as funded by the taxpayer, was set out by the last Government in their policy of December 2007. Hon. Members should look at the text—it is there in the record.

The last Government were right. The right hon. Member for Wentworth and Dearne seeks to set up an Aunt Sally when he says that there is something wrong with European principles of competition law when applied to health care. Let us be clear: if we are spending £100 billion of taxpayers’ money on securing high-quality health care on the principle of equitable access, what is wrong with insisting on the principle that we should not allow monopolists to restrict the choices available for using that budget to deliver high-quality care for patients? That is the principle, and that is why I am in favour of competition law applying to the provision of health care in response to a tax-funded budget.

[Nadhim Zahawi]

Does my right hon. Friend agree that this is political opportunism of the worst kind?

[Mr Dorrell]

It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I will give way to the hon. Gentleman, who is another member of the Health Committee.

[Grahame M. Morris]

I am doubly honoured, because the right hon. Gentleman has afforded me a courtesy that the Secretary of State would not. The concept of having greater clinical engagement—not just for GPs, but for doctors in secondary care—enjoys broad support across the parties. However, the framework laid out in the Health and Social Care Bill opens the service up to privatisation.

[Mr Dorrell]

I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.

Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.

[Mr Brine]

Will my right hon. Friend give way on that point?

--- Later in debate ---

[Mr Dorrell]

If my hon. Friend will forgive me, I will not.

There are two other important principles, one of which was espoused by the hon. Member for Leicester West (Liz Kendall) when she worked for Patricia Hewitt. That is the principle that all NHS providers should be foundation trusts, in order to provide a level playing field, and to ensure that commissioners have a fair choice and that we deliver good value, high-quality care for patients. Finally, there is the principle of “any willing provider”, where the Labour party provided us not only with a policy, but with a slogan and an election commitment to implement that policy. Now Labour wishes to desert both the policy and the slogan in its election manifesto.

This debate makes me feel as though the last 20 years never happened. It could have happened at any time between 1990 and 1997; and in fact it did—many, many times. What has happened since is that Labour in government picked up those principles and sought to put them into effect. Now, less than 12 months after the general election, it has reverted to type. It is as though nothing happened in the past 20 years. We have heard industrial quantities of nonsense this afternoon, and I hope that the House will reject the Opposition’s motion.

--- Later in debate ---

[Andrew George]

I am prepared to talk to anyone who wants to engage constructively in improving the Bill to ensure that it achieves its stated intentions, because I do not think that it will, given the nature of the reorganisation proposed in it. The reason I will not be joining the hon. Lady and her colleagues in the Lobby to support the motion is that it is tactically wrong at this stage to engage in such antics. This issue is a great deal too important to be turned into a party political playground game.

I am pleased that the Secretary of State said today that he is prepared to listen and engage. We need to explore every opportunity to engage in constructive dialogue with him, involving all the stakeholders I mentioned, and, indeed, those in the Labour party who want so to engage, to find a way through and to ensure that the genuine concerns about the impact of the Bill are properly scrutinised. Yes, they are being scrutinised in the Bill Committee, but before we get to Report stage in this House, it is important that we create a coalition of the bodies that share these concerns. Rather than inviting them to go out on to Parliament square and wave their placards and so on, it would make a lot of sense to encourage them to engage in greater constructive dialogue than we have succeeded in achieving so far.

[Mr Dorrell]

Does my hon. Friend agree that the case he is making is reinforced by the fact that our right hon. Friend the Secretary of State has already moved two amendments to the Bill dealing with the cherry-picking issue and—this was mentioned by the Prime Minister today—price competition. The amendments have been tabled to ensure that the Bill addresses concerns expressed by the hon. Gentleman and some of his hon. Friends.