Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I certainly can. The number of diabetes sufferers overall will go up from about 3.7 million, which is already 5% of the population, to 4.4 million. We need to do a lot better in how we look after people with long-term conditions if the NHS is to be sustainable. We can also do a lot to transfer the individual care of people who have diabetes through things such as technology, which I will look into carefully.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?

[Mr Hunt]

My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

In fact, in October 2010 this Government took an important decision about the funding of social care: to invest an extra £7.2 billion. I wish Opposition Members would stop running local authorities down and support the ones that are doing the right thing and ensuring that they spend the money the Government have provided to them on social care, rather than cutting those services. That is what I am doing; I hope that the hon. Lady will as well. I just wish that she had prefaced her comments by apologising for 13 years of Labour failure on social care.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?

[Paul Burstow]

Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.

National Health Service

Stephen Dorrell Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

There is a simple answer: yes, we will repeal the Act. It is a defective, sub-optimal piece of legislation and it is saddling the NHS with a complicated mess. The hon. Gentleman should listen to the chair of the NHS Commissioning Board, whom his Secretary of State appointed. He has called the legislation “unintelligible”. In those circumstances, it would be irresponsible to leave it in place.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the Chair of the Select Committee in a moment.

Wherever we look, we see warnings of an NHS in increasing financial distress, yet according to Ministers everything is fine. The gap between their complacent statements and people’s real experience of the NHS gets wider every week. They are in denial about the effects of their reorganisation on the real world. That dangerous complacency cannot be allowed to continue.

--- Later in debate ---

[Andy Burnham]

One of the great tragedies in this book is the Secretary of State’s admission, during a statement in the House in which he announced the “pause”, that he could have done most of what he wanted to do without legislation. The former Secretary of State, the right hon. Member for Charnwood (Mr Dorrell), is quoted as muttering to a colleague, “Why on earth are we doing it, then?” Well, why on earth did he do it? Because he wanted his Bill, regardless of other people.

[Mr Dorrell]

A moment ago, the right hon. Gentleman told my hon. Friend the Member for Winchester (Steve Brine) that Labour was committed to repealing the Act in its entirety. Does that not mean that an incoming Labour Government would be committed to precisely the kind of pre-cooked reorganisation of which he has just accused my right hon. Friend the Secretary of State?

[Andy Burnham]

No, it does not. This is what Government Members do not understand. It is not about the organisations, but about the services that they provide. The existing organisations can be asked to work differently, and I would ask them to work differently. I do not want NHS organisations to be in outright competition, hospital versus hospital; I want them to work collaboratively. So yes, we will repeal the Act, but no, there will not be a pointless top-down reorganisation of the kind that we have seen the Secretary of State inflict on the NHS.

This complacency is dangerous, and it cannot be allowed to continue. We had two clear purposes in initiating today’s debate. First, although we cannot stop the Government’s reorganisation, we can hold them to account for promises that they made to get their Bill through. I shall shortly identify five such promises in respect of which we are asking Ministers to live up to their words. Secondly, we wanted to give the House a chance to help the NHS by voting to hold the Government to account and enforcing the coalition agreement’s commitments on NHS spending.

Let me first deal with Ministers’ claim that there is no evidence of rationing of treatments by cost. They have promised to act if any evidence is presented. In fact the evidence is plentiful, and it is simply not credible for Ministers to deny it. The postcode lottery of which we warned is now running riot through the NHS. We have identified 125 separate treatments that have been stopped or restricted in the past two years, in some cases in direct contradiction of guidance from the National Institute for Health and Clinical Excellence.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame M. Morris), who is a member of the Health Committee. I hope he will forgive me if I do not follow him down the specialist course of radiotherapy services.

I want to address my remarks primarily to the shadow Health Secretary and to begin with an echo from a different era. When I first came to the House, there used to be something called “Whitelaw’s law”, which, obviously, referred to the late Willie Whitelaw. “The more he blusters,” we used to say, “the less he believes it.” The shadow Health Secretary gave us an Olympic-class demonstration of the principle of Whitelaw’s law. He blustered from the Dispatch Box and got himself into several dead ends. It became clear that he did not really believe that he had answers for the challenges facing the NHS.

I refer the right hon. Gentleman to a point that he made and which I agree with. The most important statement about the current state of the health service was not made by him as Secretary of State—and, with great respect to my right hon. Friend the Secretary of State, it was not made by him either. It was made by Sir David Nicholson in his annual report to the national health service in May 2009, and it was endorsed by the right hon. Gentleman. Sir David said, looking forward to the period of this Parliament:

“we must be prepared for a range of scenarios, including the possibility that investment will be frozen for a time. We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over the three years.”

I agreed with what the shadow Secretary of State said about the importance of what we, in the Health Committee, dubbed “the Nicholson challenge”. I believe that that is the central challenge facing the national health service. The sadness in this debate was that the right hon. Gentleman gave us no hint as to how he believes the health service should address that central challenge about which he and I agree.

[Mr Graham Stuart]

Meeting that challenge, and dealing with the challenges in the NHS generally, would be all the more difficult if one believed, as the right hon. Member for Leigh (Andy Burnham) does, that real-terms increases in investment in the NHS are irresponsible.

[Mr Dorrell]

I agree with my hon. Friend, but let us not go down that route. At the time when Sir David Nicholson was writing, the Labour Government were contemplating the possibility not of a real-terms freeze, which is in effect what is planned under the coalition, but of a cash freeze, which would have been substantially more difficult to achieve.

The main issue now is how we deliver services that meet the demands placed on the system against the background of a resource allocation to the health service that was always going to be dramatically less generous than it was during the earlier years of the Labour Government. We heard from the right hon. Gentleman a commitment that an incoming Labour Government would go through a clean-sheet-of-paper redrawing of the map—

[Andy Burnham]

indicated dissent.

[Mr Dorrell]

The right hon. Gentleman shakes his head, but he said that he would repeal the Health and Social Care Act 2012, the result of which would be to commit the health service to precisely the kind of reorganisation—or re-disorganisation—that he accuses the Government of introducing.

The challenge for the Opposition is to show that they are willing to map a future for the health service, in much more constrained financial circumstances, that allows it to meet the demand for services that is going to be placed on it and to fulfil the aspirations that we all have for improved quality of service. That becomes increasingly difficult in the light of motions such as the one that the right hon. Gentleman has put down for the House to consider. He invites us to regret

“the increasing number of cost-driven reconfigurations of hospital services”

and

“growing private sector involvement in both the commissioning and provision of NHS services”.

Yet when he was Secretary of State and bore my right hon. Friend’s responsibilities for meeting this challenge, he made it clear that service reconfiguration was precisely how the health service needed to meet the challenges that it faced, and that the private sector had an important role—of course, not an exclusive role—in introducing the solutions to the challenge that Sir David Nicholson articulated in May 2009. The same approach was taken in the Labour party’s manifesto for the 2010 general election.

The challenge that the right hon. Gentleman has to address if he is to discharge his responsibilities as shadow Health Secretary is to move on from party political ding-dongs, of which we have had too many. [Interruption.] The right hon. Member for Holborn and St Pancras (Frank Dobson) is commenting from a sedentary position. I have always been aware that he, at least, does not agree with the commissioner-provider split that the shadow Health Secretary operated as Secretary of State and has always said that he is in favour of considering.

[Frank Dobson]

Would the right hon. Gentleman care to confirm for the House that in the last year when he was Secretary of State, NHS hospitals carried out 5.7 million operations and at the end of the Labour Government’s period in office it was carrying out 9.7 million operations?

[Mr Dorrell]

I am grateful to the right hon. Gentleman for drawing attention to the fact that throughout the history of the health service, under Governments of all political complexions, there has been a growth in the level of services, and improvement in the quality of services, provided to patients. It happened under the Tory Government of whom I was a member and under the Government of whom he was a member. Of course, that is delivered not by the politicians but by the doctors and nurses who work in the health service.

The challenge faced by the current generation of policy makers, including the shadow Health Secretary, is how to meet the rising demands and the requirement for improved quality in much more constrained financial circumstances than I or he faced as Secretaries of State. He signally failed to meet that challenge today.

Care and Support

Stephen Dorrell Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the package of measures that my right hon. Friend has announced, which represent important progress towards the delivery of many objectives that are, as we have heard, shared across the House. May I ask him two specific questions? First, he has published a welcome draft Bill showing that many of these aspirations can be brought into effect. Do the Government expect to be able to provide time to make that draft Bill law in the next Session of Parliament? Secondly, in the context of that Bill, does he hope that the continuing cross-party talks may yet provide the basis for answering the funding question that has bedevilled those talks for so long?

[Mr Lansley]

I am grateful to my right hon. Friend. It was neglectful of me not to mention that the White Paper and the announcement that I have made also drew on the recommendations and work of the Health Committee, and I am pleased to have been able to respond to its report as well.

First, matters relating to the legislative programme for the next Session will be announced in the normal way in the Gracious Speech. Secondly, I am determined that we will not only, I hope, have continuing cross-party talks but that they will be conducted, as I think that the shadow Secretary of State himself would wish, with the sector in a more open, public debate. If we were able to arrive at a position whereby, notwithstanding the fact that funding decisions might be made in the spending review, there was scope to put in place legislative provisions that allowed that to happen and could be agreed in time for the introduction of the draft Care and Support Bill, then we would look to make that happen. However, that is conditional at this stage.

Cosmetic Surgery

Stephen Dorrell Excerpts

Thursday 5th July 2012 Westminster Hall

[Mr Stephen Dorrell (Charnwood) (Con)]

I think my hon. Friend the Minister might need some time; she will respond to views expressed by members of the Select Committee on Health, and other hon. Members who have forsaken attractions elsewhere and turned up to this debate.

The Health Committee is grateful to the Backbench Business Committee for nominating this subject for debate this afternoon. Our report on PIP breast implants aroused considerable interest among those directly affected. That is hardly surprising, because it addresses an issue of major concern for more than 40,000 women who have received breast implants that were later found to be non-compliant with standards that everyone believed they met on the day the implantation took place. That has led to considerable concern among a large number of women about the health implications of that failure of an implantation into their body, and it also raises important policy issues that the Committee has sought to address in its two reports on the subject, to which the Government have sought to respond. We now think that the issue merits wider debate.

I will begin by stating relatively briefly how we arrived at this set of circumstances. The breast implants supplied were subject to European law and a European licence that was issued by the French regulatory authorities. I will not amuse the House by offering a French accent because, happily, the words in question are similar to their English equivalents: Poly Implant Prothèse, or PIP, is, or rather was, a French company that had a licence to deliver those products. In plain English, it was not merely a question of the company not complying with the terms of the licence. French regulatory authorities have acknowledged that fraud took place, and that falsified returns were made to the French regulators. However, not only did the breast implants supplied by PIP not comply with the regulations, but the company knew that at the time they were supplied.

The licence was issued and maintained by the French authorities, but in March 2010—the date is significant—the French regulator reported the existence of fraud within PIP, and stated that the implants that the company had supplied contained non-compliant silicon. As a result, the product was deliberately not the one that had been licensed for supply and use in human surgery.

There was then a long period—I intend to return to this issue—between March 2010 and December 2011 during which it was unclear to the Committee, as we undertook our inquiries, whether anything like a proper reaction was expressed by the French regulators or, it must be said, the regulatory system in this country. I will later return to, and dwell on some of the lessons to be learned from what happened in that time lapse between March 2010 and December 2011.

Before I consider the substance of those issues of concern to the House, I would like to complete the timeline. One might think that the announcement that there had been a fraud, and that non-compliant breast implants were being supplied, would have raised concerns and prompted somebody to do something about the matter in March 2010. As I said, however, nothing much happened until December 2011, when more or less out of the blue—at least as far as we could make out—the French regulator announced that it had decided that even though 21 months had elapsed, its concerns about the implants were now such that it recommended “precautionary removal”, as it is phrased. By Christmas 2011, the recommendation from the French regulator was that the implants should be removed forthwith—no, not forthwith; on a non-urgent basis.

Over 21 months, therefore, the regulator had gone from frankly not doing much about the issue to announcing, just before Christmas, that its concerns were such that there should be a precautionary removal of the implants. On the basis that nothing ever happens at a convenient time, that took place just as everybody was going away for Christmas, and my hon. Friend the Minister and my right hon. Friend the Secretary of State therefore had to deal with the issue during the Christmas holidays. During that period, the Government set up two inquiries. One was led by the medical director of the NHS and focused, rightly, on the priority subject, which was the risk to patients and the proper response in terms of patient care. The other inquiry was led by the Health Minister in the House of Lords, Lord Howe, who looked at the policy lessons from the point of view of the regulators.

The Committee heard evidence in February and issued its report in March. The Government responded, and we now have the question of the lessons to be learned, and the Committee’s response to the Government’s position. The Government have accepted the Committee’s recommendations in the report, with two important exceptions. I wish to talk about those exceptions, and then deal with one or two other issues raised by the Committee on which it would be useful to hear the Government’s current thinking.

The first issue concerns what happened between March 2010 and December 2011 and the lessons to be learned. In the Committee’s view, one of the most important lessons was that we were surprised, to put it extremely mildly, that implants can be put into the human body and no record kept of the fact. That seems to have implications that go way beyond the issue of breast augmentation. An implantation into the human body can take place and there is apparently no regulatory requirement on any of the professionals, service providers or providers of the devices to keep a record of that.

During the various inquiries held immediately after the Christmas recess, the Secretary of State said that the Government were minded to move back to the previous rather weak requirement for a register, but I hope that when the Government consider the subject, they will look not just at the context of breast implantation, but at a much wider question. It seems to me that if a medical device is being implanted into a patient, the burden of proof is on anyone who wants to argue that a record should not be kept. The PIP implant saga perfectly illustrates why there should be a record of which patient received which product on which day. It is so that a proper response can be organised if the product is later found not to have complied with the regulations on the day on which it was implanted, as in this case, or if the product is later found not to be desirable for any number of reasons that may not be known about on the date of implantation.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the right hon. Gentleman agree that the idea of a register of implants—not just breast implants, but implants in general—has been raised before, but was rejected, sadly, by Minsters in a Labour Government because officials for some reason resisted the idea, and that it is important that we push forward with that common-sense idea?

[Mr Dorrell]

I agree. In fairness to officials, it was not so much the officials who were resistant in the days of the previous Government, as I understand it; the issue was that the requirement was relatively weak, and many patients were resistant. However, for reasons that I have given, it seems to me that it should be part of the regulatory structure within which medicine is practised that implantations into the human body are the subject of very secure records.

[Mr Denis MacShane (Rotherham) (Lab)]

I agree with everything that the right hon. Gentleman is saying. Does he agree with me that there is a cultural problem, in that “regulation” has become a dirty word in modern politics—not recently, but over a number of years—and that the words “European regulations” are not so much dirty words as a total obscenity that people only whisper in dark corners of this place? The European regulations were inadequate, and we did not have the guts to insist to the professions and the people making money out of this that they needed a bit more regulation.

[Mr Dorrell]

I have some sympathy with what the right hon. Gentleman says. I do not think that we should be frightened, when the burden of proof is discharged, and when it is necessary, of ensuring that there is an adequate regulatory structure that is proportionate, not over-burdensome, and effective at delivering proper safeguards for, in this case, patients. I have been here long enough, Mr Rosindell, to know that if I want to get any political audience to be opposed to something, I have merely to describe it as European and the job is done. In this case, as it happens, I do think that there is a strong case for an effective European regulatory structure, so that the suppliers of proper medical devices, of which this country is a major supplier, do not have to go through 25 different regulatory structures to supply those products in a unified market.

[Mr MacShane]

The Chairman is getting twitchy.

--- Later in debate ---

[Mr Dorrell]

The Chairman, of course, is neutral in all matters when he is in the Chair, but I propose confining myself to the substance of the argument, Mr Rosindell, which is that there is a strong interest in this country, from a commercial point of view and, more importantly, the point of view of patients, in ensuring that there is a proper regulatory structure that provides for an audit trail of where products have been implanted. I would be grateful if the Minister could respond on the Government’s current thinking on that subject.

The Committee was concerned about the regulatory response during the 21-month period. With great respect to the Government response, I am sure that, seen from the helicopter, people were doing their best, but if 40,000 women are told in March 2010 that, in effect, an implant in their body is the subject of a fraudulent regulatory failure, and no response is made to them as patients for 21 months after that, that is not, in my view, an adequate regulatory response. An important part of the reason why that happened was that there was not an adequate information base to allow people to follow up, and to take the necessary action vis-à-vis those patients.

That is the first set of issues that arise from this saga. The second set of issues is more precisely about the decision-making position of the Government, and the NHS offer to patients who received the faulty, substandard implants. The Committee said, and the Government agree, that there is a clear moral and legal duty on the clinics that provided the implants to remove them and replace them at their own cost. Everyone, including the Government, agrees on that.

We also said as a Committee that we welcomed the fact that by the time we held our hearings, the Government had made it clear that the NHS was the back-up provider. If there was a faulty implant and no one else was going to remove it, the NHS, as a public health authority, needed to be able to be that back-up provider of a proper public health response, with, of course, the important proviso that if the NHS removes a faulty implant in those circumstances, it has a perfect right to recover the cost from the people who put it in. Again, there is no argument there.

The argument arises when a patient who has received a substandard implant has it removed in those circumstances by the NHS, but wants a replacement implant. Currently, the patient will need to have surgery to have the faulty implant removed, be discharged, and go to a different hospital on a different day and again take the risks—they are relatively small risks, but they are risks none the less—associated with any clinical procedure in order to have a replacement implant put in place. The reason given for that—I am very familiar with these arguments because of my background in the Department—is that the NHS cannot do a single operation where part of it is at public expense and part of it is at the individual’s expense. In the jargon of the NHS, there cannot be top-up charges for a single procedure.

I understand the NHS theology that lies behind that, but I recoil from the consequence, because what it says to the women—it is a relatively small number of cases—is that they have to go through surgery twice. There is a cost implication to that, but much more importantly, there is a clinical implication that I would have thought any doctor would recoil from. I urge the Minister to think again, and to think more imaginatively about the application of the familiar doctrine, which no one in the House would disagree with, that we should not have top-up charges in the NHS. I urge her just to think about the practical implication for the woman in those circumstances. I hope that the Government will find it possible to think again on that issue.

I would like to talk about a number of other issues that have arisen following our report. They mainly arise from the final report of Sir Bruce Keogh on the clinical consequences of this product failure. First, we welcome—I certainly welcome—the fact that Sir Bruce has finally confirmed what the women themselves told us: these products have a significantly higher rupture rate than other products supplied for the same purpose. I make the point to emphasise that if we had had a proper register, that would not have been a secret. That would have been clear in the evidence, and it should have led to a challenge to the terms of the licence as soon as that evidence became available. However, the evidence was initially debated and has only now been confirmed, two and a half years after the licence for the product was removed. Evidence is there when we look for it; we need to make certain that it is there in a proper way.

The second issue is Sir Bruce’s finding that there is no evidence of long-term clinical harm being caused by ruptures. I have not mentioned this yet, but the Select Committee organised a web forum. We are very grateful to the dozens of women who contributed to that forum to make it clear that the views that we had been expressing were supported by those most directly involved. Many contributors to the forum simply do not accept that there is no clinical consequence from a rupture of the implants. Sir Bruce recognises the short-term clinical consequence, in terms of soreness, but argues that there is no evidence of long-term clinical consequence. The women most directly affected are not convinced that that is true, and we can all understand why. That is the finding of Sir Bruce’s group now, but what process will we set up to ensure that it is not a once-and-for-all finding? It is one thing for it to be a judgment at a point in time, but if evidence that changes our understanding comes to light today, tomorrow or the day after, we must be clear that the finding is subject to ongoing review.

My third question concerns the clinic licensing system. I want to read some of the contributions to the web forum. They pose a question about the clinic licensing system, which continues to allow clinics to provide this service—subject, as probably should be the case, to the clinic having a licence. One woman said:

“it took weeks for them to respond to any emails, even though I knew I had PIPs and had 4 of the symptoms which they stated on their website.”

That organisation continues to provide this service. Another respondent said:

“The clinic were very slow to respond. At first they answered the phone and dismissed my concerns saying there is no proof PIP’s are unsafe/no link with cancer. They then stopped answering calls at the clinic and calls diverted to a call centre”.

A third respondent said:

“I contacted the provider who told me as I had had the implants for over 10 years…there was nothing he could do”,

because

“they should be changed after 10 years. This was news to me as when I had them originally done I was told they would last…15–20 years”.

Those organisations still have a licence. I put it to the Minister that that is not compatible with the delivery of good standards. Every one of those accusations—and no doubt there will be many more—should be followed up by the regulator, and the performance of the individual clinic should be tested.

I apologise, Mr Rosindell, for going on slightly longer than I had intended. Finally, there is an issue that came to light in the Committee hearings that I would like to question the Minister on: the challenge for the medical professions, and the individuals responsible for and engaged in the delivery of this service. The service was delivered in clinics, but the operations were performed not by the clinics, the system, or the venture capitalist, but by a doctor in a surgery with a patient in front of them. Like all medicine, it was one to one, and, like all medicine, it is subject to regulation by the professional regulator—another form of regulation of which I am strongly in favour.

The challenge to the professions that deliver such services, whether in the public or private sector, is to show that the duty of care that the professional owes to the patient was properly discharged and enforced. I will quote again from the web forum to illustrate why I am not convinced that that happened, particularly in regard to the obligation that a clinician has to advise a patient on the consequences and implications of a procedure that they are about to undertake. A woman said that a nurse at the clinic that she went to

“told me that she could see no reason why I wouldn’t take these implants to my grave as they were so good.”

As not many women have such operations in their 80s, and as women these days live into their 80s, it seems unlikely that that was clinically appropriate advice to give. Another woman said that she

“was assured that implants never need to be replaced”.

Whoever gave that assurance was quite clearly in violation of their professional obligation to give good advice to their patients. Another said:

“My surgeon told me that PIPs were the best and most expensive available and that they should last a lifetime.”

The evidence available is that even if they were the best and most expensive available, which they were not, they had a lifespan of between five and 10 years. They certainly were not designed to last a lifetime, and no clinician should have given that advice to their patient.

In conclusion, this saga throws a very unflattering light on the professions and the regulatory structure in this part of medicine. It also raises questions that have application well beyond the world of breast augmentation surgery. I look forward to the Minister’s response to the questions that I have raised, because I suspect that the issue will not go away any time soon.

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[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to follow my hon. Friend the Member for Bosworth (David Tredinnick), and, indeed, all the hon. Members who have spoken. I pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell), who has worked very hard on putting together a good Select Committee report, championed the cause diligently over the past few months in Parliament, and helped to bring about this debate.

One thing that came across from the remarks of all right hon. and hon. Members, but which was highlighted particularly by the right hon. Member for Rotherham (Mr MacShane), is the concern, which unites the House, for the women who have been exploited and, in many cases, treated badly by some private sector cosmetic providers.

The expert group appointed by the Department of Health published its report on 6 January and concluded that there was no causal link between PIP implants and cancer, and on 1 February the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks published its report on the matter, which reached similar conclusions. Although there may not be a risk of cancer, we know that PIP implants are not of good quality, and their rate of rupture is six times greater than that of other implants. It is because of that inferiority, and the concern and worry that it has caused many women, and because of wider issues about the cosmetic surgery industry, that we are having this debate; and those are the issues that I want to talk about.

To me, the primary issue is duty of care. NHS providers, whether traditional ones or private providers commissioned by the NHS, have a duty-of-care relationship with their patients, whether women or men. Clearly, in the cases that we are considering, the cosmetic industry has not shown that duty of care because of the contractual relationships that women were in.

My right hon. Friend the Member for Charnwood highlighted the problem of the Medicines and Healthcare products Regulatory Agency failing to keep a sufficiently vigilant eye on PIP or other implants, and I do not want to dwell on that. However, the cosmetic industry’s wider role, and the governance and culture of not only plastic surgery and cosmetic clinics, but the surgeons and others in the industry, are key to how we improve—how we take matters forward and make things better for women in the future.

On the duty of care, all the women whom we are talking about are patients. If an invasive procedure is performed on someone’s body, they must be considered a patient—someone to whom a duty of care is owed. It does not matter if the procedure is done by the NHS or a private provider outside the NHS, as in the cases we are considering. That duty of care should exist. Yet with the cosmetic industry, because there is a contractual relationship, it is clear that that duty of care does not exist and that many of the women have been exploited, potentially, and misinformed by the cosmetic industry. The relationship has not protected women or acted in their best interest.

[Mr Dorrell]

I hope that my hon. Friend would agree that the mere existence of a contract between the provider and the patient does not in any way undermine the duty of care that the one owes the other. As I said, a surgeon who provided the service without giving proper advice to the patient would be in violation of their professional duty of care to the patient, and the provider would not be providing the service required by the contract, either.

[Dr Poulter]

I fully agree. Unfortunately, although a contractual duty should inherently also be a duty of care, in this case there has been poor medical practice and poor medical accountability on the part of some surgeons in a number of clinics—a point highlighted by my right hon. Friend, and by the right hon. Member for Rotherham. Some providers have not behaved with the kind of responsibility and care for their patients that we would expect of anyone offering a service, particularly one involving invasive bodily procedures.

My right hon. Friend the Member for Charnwood was right to highlight the doctrine of top-up charges, because women have, in some cases, been forced to have two operations in order to have their implants replaced with better ones. That is not only unacceptable medically, but also on the basis of the duty of care. Given that many cosmetic surgery clinics that work under a contractual arrangement cannot claim back money under their insurance when the data do not necessarily show a risk from PIP implants, they are not in a position to offer the replacement procedures without going bankrupt. Although they have a moral duty to offer those procedures, they are not always in a financial position to do so, and that goes to the heart of the matter.

When people take up private procedures outside the NHS, and a contractual duty is in place, there needs perhaps to be a levy on the private providers to ensure that when things go wrong, other providers—either in the private sector or the NHS—can ensure that things are put right. I would be grateful if the Minister could reply on that suggestion of a course of action that the Government could look into. We want our primary concern to be the care of the women affected, and there are providers that, as my right hon. Friend the Member for Charnwood says, consider themselves to have a duty of care, but are, because of the financial consequences, perhaps unable to put things right. We might, therefore, need a levy or some kind of insurance to safeguard against such a situation occurring again.

I want to touch on the governance of the plastic surgery industry. The professional responsibility of plastic surgeons and everyone involved in the industry should be no different from that in other parts of medicine, but we have seen some very bad practice by some cosmetic surgeons. Earl Howe’s report states that under General Medical Council guidance and rules for good governance, there is a duty on doctors and other medical professionals to have good auditing and record keeping, but far too often, data on the care of the women affected have not been properly kept. Good medical records do not exist, and there has been a neglect of duty by some medical professionals. As my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, that is something for the GMC to look into, and I am sure that the Royal College of Surgeons will look into that in further reviews.

We need to ensure that regardless of whether a procedure is carried out in the NHS or the private sector outside the NHS, good medical practice as regards audit and record keeping is always maintained. When things go wrong with the cosmetic industry and private operators outside the NHS, it is always the NHS that picks up the pieces, and NHS doctors therefore need to be put in the best position from which to look after the patients.

Finally, the exploitation of women in many of these situations has been talked about widely. The Committee has heard of many cases of women having gone in good faith to cosmetic providers and having received at best inducement, and at worst poor information, at the moment of consenting to an operation. The basis of all medical treatment is informed consent. A patient should understand the consequences of any operation, be fully availed of the facts, and together with a medical professional, make an informed decision about the right way forward and about how they should be treated. Far too often, the evidence has shown that women do not give informed consent and are not fully availed of the facts. That is bad medical practice and, as my right hon. Friend the Member for Charnwood pointed out, it is an issue for the cosmetic industry. The Royal College of Surgeons and the General Medical Council should investigate surgeons who have not done things in accordance with good medical practice, as set out by the GMC.

We need to consider the wider consequences, and to move the cosmetic industry from a purely contractual arrangement towards one involving a duty of care. We need to consider ways of properly looking after women when things go wrong and, given the doctrine of top-up charges, we must ensure that money is available to look after women. Perhaps there is a role for a levy on private operations. We must also ensure much greater accountability of medical professionals and better record taking, so that we can have proper patient care, which is what we all want. I am pleased to have taken part in the debate, and I look forward to the responses of the Minister and the shadow Minister.

--- Later in debate ---

[Anne Milton]

Thank you very much, Mr Rosindell. I am also grateful to my hon. Friend the Member for Bosworth (David Tredinnick). I was not aware that we were allowed to run on.

I am grateful to the Liaison Committee for choosing the topic for debate and to my right hon. Friend the Member for Charnwood (Mr Dorrell) for the thoughtful way in which he introduced it. I concur with the statement made by the shadow Minister about the usefulness of the Backbench Business Committee. It has allowed us all to raise issues of interest to our constituents in a much more timely fashion.

I welcome the opportunity to set out the Government’s position. My right hon. Friend described much more eloquently than I could the events that led up to what has happened. The stress that the women concerned have gone through has been immense. I am disappointed that the shadow Minister was slightly party political in her response. The right hon. Member for Rotherham (Mr MacShane) said that the issue is not very party political. I gather from the debate that the matter has been on the stocks since 1994. It is time for us to shine a light—possibly this issue has done so—on cosmetic surgery and, indeed, on interventions. We need to make sure that we get our house in order.

The women concerned believed that they had received breast implants containing silicone that was safe and of medical quality. They certainly did not expect to discover that they had been, in some cases, cruelly and cynically deceived and that their interests had been ignored through the fraudulent activity of the manufacturer. Over the past few months, I have met a number of women with PIP implants. They all feel, as do I, that the right lessons should come from what has happened. In fact, although the women concerned certainly do not want to be in the position they are in, they are keen to know that the Government will learn some lessons.

We should start with the science. I assure the shadow Minister that, of course, as with anything, research and review of practice is ongoing. One does not just carry out a review of research and end it there, because research continues. It is extremely important, and not only in this country, that we continue to learn lessons from ongoing research on a number of issues and that we remain open-minded.

Within weeks of the discovery of the fraud, the MHRA commissioned tests to find whether the material in PIP implants was dangerous. Because of legal difficulties over similar tests in France, the MHRA was the first agency in a position to publish the results of that testing, in September 2010. For obvious reasons, the tests were based on a limited number of samples, but the conclusions at that time were relatively reassuring. More tests were then carried out in France and Australia during 2010 and 2011. The results were broadly similar to ours, apart from some inconsistencies over a test for skin irritation.

Towards the end of 2011, the French regulator began to notice that more people were reporting that their PIP implants had ruptured. There was a report of a rare form of cancer in one woman with a PIP implant. The French cancer institute looked at the data and decided that there was no excess cancer risk associated with PIP implants. Nevertheless, as a precaution, the French Government decided to advise all women with PIP implants to have them removed. A number of European countries followed suit.

We, in the UK, decided that an expert group chaired by the NHS medical director should look at the evidence and advise on appropriate policy for the NHS in England. The expert group delivered an interim report within a matter of days; it advised that the evidence at that time did not justify removing all PIP implants as a matter of course. Instead, the group advised that women should speak to their specialist and come to a decision individually. However, it also noted that the evidence base was not perfect, and said that it would collect more information and advise further in due course. I understand that the Health Committee supported that decision.

I am sorry if the shadow Minister feels that anybody from the Government has not appeared sympathetic. It is certainly not a view I have heard expressed. It would be hard not to sound sympathetic when people have been the victims of what, as I said at the beginning, were the cruel and cynical actions of a fraudulent company. I have met a number of the women concerned since then. I hope not only that lessons will be learned, but that any Government procedures will ensure that responses are more timely.

[Mr Dorrell]

On the evidence of toxicological damage, one of the things that the women most directly affected are seeking is more precise detail about the evidence that has been used by the MHRA to reach its conclusions. Will the Minister clarify whether that is to be published or whether there is a constraint that prevents its publication?

--- Later in debate ---

[Mr Dorrell]

I am sorry, but I am going to have a go at my hon. Friend the Minister, and not on the subject of gold fillings. Her point is that if a provider removes the faulty implant on the NHS and then goes on to provide a paid-for replacement of the implant, the NHS somehow becomes responsible for the ongoing maintenance of the replacement implant. However, that assumes that we consider the provider hospital as the NHS for that purpose. We all know that NHS hospitals provide private care. The NHS does not accept responsibility for that private care. If the patient pays in an NHS hospital for care, it is private care, and the NHS is not responsible for paying for follow-on care. If a patient who happens to be in a private NHS hospital pays for a new implant and that half of the procedure is private, I genuinely do not understand why the NHS would suddenly become responsible for it on an ongoing basis.

[Anne Milton]

That may be a subject for a Backbench Business Committee debate on co-payments and what the NHS is and is not responsible for. The difficulty is—

--- Later in debate ---

[Mr Dorrell]

I propose to be extremely brief, Mr Benton. We have already trespassed on the time of the following debate.

I am very grateful to my hon. Friend the Minister for the way she responded to the debate. I hope that she will continue to think about the challenge of what my hon. Friend the Member for Bosworth (David Tredinnick) called “double jeopardy”. I hope that she will take forward work on a proper register, because that is the best way of making certain that things are handled better in future.

backbench business

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

Yes, I read that letter this morning. Today, elsewhere in the House, the permanent secretary to my Department and the chief executive of the NHS will give evidence to the Public Accounts Committee on precisely that issue. In the context of doing so, they will demonstrate how we have continued over the past two years to achieve a substantial year-on-year increase in the number of patients with diabetes who are accessing best-practice services.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?

[Mr Lansley]

I do believe that and the legislation requires it of clinical commissioning groups and health and wellbeing boards. The relationship being built up between clinical leadership in the NHS and democratic leadership through health and wellbeing boards is an instrumental part of delivering that integrated care.

Oral Answers to Questions

Stephen Dorrell Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

I absolutely agree with the hon. Lady’s constituent, and with the hon. Lady. We need to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that we can roll this out nationwide by 2014, but I know that the hon. Lady is having discussions with the authorities in Sheffield, and I encourage her to carry on those conversations about the way in which people can use the current arrangements to access those facilities.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does the constituency case raised by the hon. Member for Sheffield, Heeley (Meg Munn) not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the national health service, in order to provide joined-up care that focuses on patients’ needs and delivers better value for money to the taxpayer?

[Paul Burstow]

My right hon. Friend is absolutely right. I urge the hon. Lady to write to me about the matter so that I can respond in more detail, but let me say to my right hon. Friend that it is not just a question of delivering more integration within health care—which is often still too fragmented—or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill, which has now completed all its stages, gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for individuals.

Health and Social Care Bill

Stephen Dorrell Excerpts

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham]

I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will not give way. I will now bring my remarks to a close.

We are clear that the risks in the Bill arise not just from the organisational turbulence that the Secretary of State is inflicting on the NHS, but from the specific policies in the Bill. Today we table a package of amendments in a last-ditch attempt to provide the necessary safeguards that the Liberal Democrats failed to secure in another place—

[Mr Dorrell]

On that point, will the right hon. Gentleman give way?

[Andy Burnham]

They are safeguards in light of the huge potential for the conflict of interests in the award of contracts under the “any qualified provider” provisions, which will not be addressed by a simple register of interests, and safeguards on a stronger local HealthWatch—the Government have watered that down since the Bill left this House of Commons. There are safeguards too—

[Mr Dorrell]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way for one last time.

[Mr Dorrell]

I am grateful to the right hon. Gentleman. Will he just clarify one issue of principle for the House? Are Labour Front Benchers now arguing that every Government Department should publish its strategic risk register? If not, can he justify his proposition that the Department of Health should do so uniquely?

[Andy Burnham]

I refer the right hon. Gentleman to the Information Commissioner’s ruling on the decision about a third runway at Heathrow. That is the precedent his Government should be following, but instead they have chosen to defy the commissioner. It was the Labour party that published the decision on a third runway at Heathrow, and I refer him to the ruling from the Information Rights Tribunal, which made a clear distinction between the strategic risk register, which covers all the uncontrollable risks that any Department will face, and the transition risk register, which deals specifically with the effects of Ministers’ decisions, in this case on the NHS. There is a real difference between the two. The tribunal said that the transition register should be published. His Government should respect the law and publish today.

We will table amendments to provide safeguards today, but in future it will not just be the cover-up of the risk register that we will have to worry about—that is just a taste of things to come in the new NHS. Members will have to get used to the words “commercial confidentiality” when inquiring about local services, because that is what they will find in the NHS that Ministers are creating. Let us look at the risks inherent in the proposed relaxation of the private patient income cap. One risk assessment that Ministers have published—the revised impact assessment—states that

“there is a risk that private patients may be prioritised above NHS patients, resulting in a growth in waiting times for NHS patients.”

That is all they have told us, but that alone is reason enough to oppose the Bill.

The only hope I can give people worried about the future of the NHS is that this might be the end of the Bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes and will not deteriorate overnight. We will be working to mitigate the worst effects of the Bill. This is the eleventh hour; our only hope would be a change of heart from the Liberal Democrats. We will call a vote on this motion and ask people to vote against it to show that we have not had enough time to debate these important issues.

I respect those Liberal Democrat Members who have had the courage to defy their orange book leadership, and I respect their grass-roots members who did the same at their spring conference, but the truth is that from today the Liberal Democrats will be remembered not only for tuition fees, but as the party that stole people’s votes in May 2012 in order to secure jobs for themselves and sell out the national health service. They could have stood up to the Prime Minister and enforced the coalition agreement, but they chose not to do so.

That brings us back to where we started: a Bill that nobody voted for, rammed through this place tonight in the teeth of near-universal professional opposition and in defiance of a major legal ruling; a Bill about which no Member of this House can look their constituents in the eye and say they have a mandate to support. Tonight Government Members will inflict this Bill on the NHS without knowing the potential damage it can do to the health service in their constituencies. They have made their choice; I have made ours. Although on a day like today it is hard for me to give any encouragement to people worried about what the Government are doing, I can at least say this: we will repeal this legislation at the first opportunity and restore the N in NHS. We have given this fight everything that we had. All I can say is that our fight will go on to protect and restore the Labour party’s finest achievement.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

Thank you for calling me, Mr Speaker, for what I hope will be a brief intervention prompted by the remarks of my hon. Friend the Member for Banbury (Tony Baldry) and the right hon. Member for Wentworth and Dearne (John Healey).

Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.

My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.

[Mr Dorrell]

It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.

[Andrew George]

Will my right hon. Friend give way?

[Mr Dorrell]

I will give way to my hon. Friend in a moment.

The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.

[John Healey]

rose—

[Mr Dorrell]

As I have quoted the right hon. Gentleman, I shall give way to him.

[John Healey]

The right hon. Gentleman is making an argument for blanket secrecy. However, this is less about his view or even mine; rather, the point is that the Information Commissioner and the judge, along with his two wing members on the tribunal, all of whom have seen and studied the risk register, have determined that, in their legal judgment, the balance of interest lies in publishing and not withholding it. Those are the facts of this case.

[Mr Dorrell]

The right hon. Gentleman is correct, but he does not go to the end of the process, because the reasons for that decision have not yet been published. The House is therefore being asked to make a decision on the basis of a judgment that has not yet been published, which cannot be right.

[Andrew George]

My right hon. Friend has argued the case on behalf of retired senior civil servants and Government Front Benchers. However, as the Chair of the Select Committee on Health, and therefore as someone who is deeply interested in effective scrutiny, does he not agree that if the Committee, of which I am a member, wishes properly to understand the potential impact of fragmentation, the conflicted nature of clinical commissioning groups, and so on, we need to find a way of getting behind the declaratory reassurances from the Front Bench?

[Mr Dorrell]

Of course I agree with the proposition in the way that my hon. Friend puts it. However, the proposition before the House is a rather more precise one: that a register drawn up in the expectation that it would remain private should retrospectively be put into the public space. The proposition that I am advancing to the House is that that is an area where we should proceed with care. We should embrace the principle that when advice is given to Ministers, it should be clear to those giving it whether it is being given confidentially or whether it will later be given over for publication. That is the simple principle that I wanted to set out.

Health and Social Care Bill

Stephen Dorrell Excerpts

Tuesday 13th March 2012 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the right hon. Member for South Shields (David Miliband) and it was notable that his hon. and right hon. Friends were listening to his words, rapt, possibly reflecting on what they had missed out on. The kernel of his argument for this side of the House appeared to be the offering of advice to us about where our party advantage lay. He will forgive me if I say that I think we should look elsewhere for advice about where our party advantage lies.

The right hon. Gentleman was raising a voice for Blairite reform of the NHS, and that is a theme to which I want to return. Some opponents of the Bill can claim the virtue of consistency. Some opponents of the Bill can claim that they always opposed the development of structures in the health services that encouraged flexibility and encouraged a focus on the patient voice and on general practitioners and the wider clinical community as an effective voice for patients in the health service.

Some can claim that they have always opposed having a health service open to private and independent sector provision alongside the national health service provision—that they have always preferred a centrally planned, state-provided service. The right hon. Member for Holborn and St Pancras (Frank Dobson), who is not in his place, can claim the virtue of consistency on that argument, but the shadow Health Secretary cannot claim that consistency because he, like the right hon. Member for South Shields, was once a Blairite. As my right hon. Friend the Secretary of State has shown with the quotations he gave from the shadow Health Secretary when he was at the Department, the shadow Health Secretary used to be an advocate of the policies that underlie this Bill. The Bill will deliver effective practice-based commissioning —a policy that the shadow Secretary of State used to espouse.

[Andy Burnham]

If this Bill simply continues our policy, why does it rewrite the entire legal structure of the national health service over 500 pages?

[Mr Dorrell]

The right hon. Gentleman knows that there is room for more than one view about the extent to which there is a need to rewrite the full statutory basis of the Bill, but that is not the issue now. The question is how, if we went down his route, had a summit and talked for another 12 months about what the institutional structure of the health service should be, that would serve the policy objective that he seeks to espouse, of greater clinical engagement in commissioning. How would it serve the policy objective of which he says he is in favour, of engaging local authorities and the wider political community in decisions that shape the future of the health service?

One issue that the right hon. Gentleman did not mention in his speech is the shift of public health out of the relatively narrow interpretation that is implicit when it is located in the national health service. Instead, public health can properly be understood as being part of the wider range of local government. Those changes do not justify some of the more ambitious rhetoric being used in support of the Bill but they certainly do not come close to justifying the rhetoric being used against it. If half the things being said about the Bill by Opposition Members were true, I and most of my right hon. and hon. Friends, and certainly my right hon. Friend the Secretary of State, would not support it.

[Dame Joan Ruddock]

In answer to a recent parliamentary question I asked about waiting lists, Ministers told me that they had no information on waiting lists for private patients. How does the right hon. Gentleman think it will be possible for NHS patients to believe that their waiting times are consistent with their need for treatment when there are no figures to indicate what happens in the private sector?

[Mr Dorrell]

One of the effects of the Bill will be to integrate the private sector more fully in the delivery of public sector services in order to meet better standards for the national health service patient whose services are commissioned by the NHS commissioner. I should have thought the right hon. Lady would welcome the fact that there was greater opportunity for the national health service patient to enjoy the benefits that have previously been available on too exclusive a basis to the private sector patient. With a proper, open-minded commissioner, those benefits ought to be available, as the Blairite doctrine advocated when the Labour party believed in it, to all patients, including, pre-eminently, the vast majority of patients who rely on the national health service.

It is claimed by the Bill’s opponents that it is in favour of privatisation, but as my right hon. Friend the Secretary of State says, there is not a single provision in it that promotes privatisation. It is said to be a Bill that promotes fragmentation. The service already suffers too much fragmentation. The Bill writes into the law an obligation to deliver integrated, more collaborative, joined-up services. That addresses the problem that has been identified, which is attributed by its opponents to the Bill. It is said to be a Bill that promotes unbridled competition. That is absurd.

It is not only the shadow Secretary of State, the right hon. Member for Leigh, who can be quoted from the past. The hon. Member for Leicester West (Liz Kendall), who is seated alongside him, has said some very useful positive things in the past. I quote from the hon. Lady in 2010:

“I’ve always believed that there needs to be some competition and challenge in the system. . . I am also a strong champion of giving patients more voice and a greater say, not only over which hospital they go to but all aspects of their treatment and care.”

I am sure the hon. Lady was speaking on behalf of those on her Front Bench. The whole Labour party used to believe in that. We believe in that. That is what the Bill provides. It builds on the policy that the right hon. Gentleman used to believe in and used to advocate. He should have the courage of those convictions.

Health and Social Care Bill

Stephen Dorrell Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

I am not sure the right hon. Gentleman even read the Deputy Prime Minister’s letter, judging from what he has just said. I will tell him exactly what the process is. The process is for detailed discussion in another place. There were 15 days of debate in Committee in another place. It is the habit in another place not to amend the Bill in Committee, but to use those debates in Committee as a basis for amendment on Report. The process is straightforward. My right hon. Friend the Deputy Prime Minister, together with Baroness Shirley Williams, explained to their Liberal Democrat colleagues some of the amendments on which we have been working together in order to make sure that there is further reassurance. [Interruption.] That is literally true.

Let me put the right hon. Gentleman right about something. What is at the heart of the Bill is improving the quality of care for patients. I note that he did not quote me or represent that he was quoting me. I have never said that competition is at the heart of the Bill. Competition is a means to an end, not an end in itself. The purpose of the Bill is to achieve quality. Where competition enables us to deliver better quality for patients, we should use it. Where integration of services and an absence of competition is in the interests of patients in delivering quality, that is the basis upon which the NHS should proceed. The Bill has been tremendously strengthened and is now a long-term sustainable basis for the NHS to deliver the quality of care for patients that we are looking for, while maintaining all the values of the NHS.

[Mr Stephen Dorrell (Charnwood) (Con)]

Has my right hon. Friend yet been able to understand how it can be that a party which, when in government, promoted practice-based commissioning that involved GPs in commissioning, promoted private sector investment in NHS institutions, and promoted the commissioning of care from private sector providers where that was in the best interests of patients now thinks all those principles undermine the national health service to which he, we and presumably the Opposition are still committed?

[Mr Lansley]

My right hon. Friend makes extremely good points. It is interesting that the right hon. Member for Leigh (Andy Burnham) appears to be trying to represent us as not agreeing about matters. He is chronically incapable of agreeing with himself. In June 2006 the then Prime Minister, Tony Blair, said that what the NHS needed in future was foundation trusts, practice-based commissioning, more involvement for the private sector and payment by results. The thing is that Labour in office did not achieve any of those things. It is only through the mechanism of the legislation that we are putting together that we are going to enable the NHS to achieve those things in a way that does not entail all the difficulties that Labour had, such as getting the private sector involvement with the NHS wrong. We are going to get those things right.