Clause 2
Health Bill
11:30 am
Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)
Amendment 4 would add a duty for NHS bodies to have regard to the core principles of the NHS which would, by amendments 5 and 6, be enshrined within the legislation. Amendment 5 lists the core principles of the NHS according to its plan. Amendment 6 sets out the redacted core principles as they now appear in the NHS constitution.
There is a recurrent theme in the regulatory impact assessment, with phrases such as
“The legislative duties reinforce the benefits of the Constitution, reducing the likelihood that these benefits will be eroded over time.”
That is in paragraph 7 of the cover note. It also states:
“The constitution should mitigate the risk of the erosion of core values”.
It is unclear whether this is an adviser extending the assessment’s word count, or if it is a slightly unnecessary and unfortunate attempt to suggest that the core values of the NHS would be under threat in advance of a general election and another Government. We would certainly argue that this is unjustified.
It is clear that the Government themselves have been responsible for the erosion of, if not the values that lie behind the core principles, at least the core principles themselves. Nine years ago the NHS plan set out 10 NHS core principles, which were endorsed by 25 organisations representing both NHS staff associations and patient groups. In that intervening period, those have become increasingly well regarded, enforced and emphasised. They are good principles and the official Opposition are committed to enshrining those principles in legislation, hence amendment 5.
Unfortunately, the Government have chipped away at those core principles for the last nine years, which, inevitably, is a cause for concern. My right hon. Friend the Leader of the Opposition has consistently confirmed our commitment that, under any incoming Conservative Government, the NHS will continue to be a public service free at the point of need, with equality of access based on need, not ability to pay. I am keen that the Government should seek to support that.
In the December 2006 consultation on the core principles of the NHS—which we have committed to enshrining in legislation and which were referred to during our debate on the previous group of amendments—undertaken by the former Minister, now the Secretary of State for Health, the Government committed to the principle that
“Public funds for healthcare will be devoted solely to NHS patients.”
I heard what the Minister had to say and intervened on him in relation to his example of prescriptions. I wanted to ensure that we fully understood this in light of the Government’s own review, the report received and the Government’s reaction in relation to top-ups, which had caused great anxiety to patients and Members throughout the House, not least on the Government’s Benches. This principle, which appears in paragraph (f) of amendment 6, remains notable by its absence. As a sub-point to principle 6—I am glad to say that we had a hand in making this happen—the Government reintroduced the phrase:
“Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves”.
“People that the NHS serves” is, of course, a much less secure category than simply “NHS patients.” I am sure that will not be lost on hon. Members.
The original core principle 4, that the NHS will respond to different needs of different populations—in truth, communities—has fallen off the agenda in such specific terms. It is important that we recognise that different communities and those with different genetic antecedents have different health needs. It is of particular concern that this original core principle of recognising the response required by the NHS for different needs in different communities has disappeared from the Government’s stated position and agenda. I am not making a party political or contentious point, but it just happens to be at a time when all of us across the House need to join shoulder to shoulder in resisting anything that could give credence to some of the most appalling, outrageous and obnoxious electoral approaches of people who stand for a party such as the BNP, where they are looking for excuses to underpin their racist, class-based, anti-communities approach. I hope that the Government will consider rowing back from this area because the original core principle 4 needs to be looked at, particularly in the light of that political context, let alone the health context.
Extraordinarily, core principle 6,
“that the NHS will support and value its staff”
has been ditched without apparent replacement. I need hardly say more: it is just extraordinary. I will listen carefully to what the Minister has to say on that, because it seems to us to be an appalling omission.
The original core principle 9 specifically and explicitly addressed health inequalities. That phrase does not appear in the constitution’s core principles. It may be simply to hide the Government’s embarrassment over their failure, over time, to reduce health inequalities, but that remains a broader debate for another day and I can assure the Minister that we will continue to have that debate.
The Government’s failure to secure compliance with the final core principle of the NHS plan, on confidentiality, has, I am sorry to say, become legendary. It is no surprise, but it is to the Government’s shame that this, too, has fallen off the agenda. It is right that the impact assessment should be concerned about the ability of a Labour Government to chip away at the principles of our NHS. We have remained committed to them while the Government have consulted on them, through the NHS plan, have set up a new set for NHS Choices and now a new set in the constitution. It is precisely for this reason that the principles that were in the original NHS plan, as we have consistently proposed, ought to be in the Bill.
In a fit of generosity to the new Minister, I have included the core principles as laid out in the NHS constitution in amendment 6. If he is unable to support his Government’s original proposals, by way of supporting amendment 5, the NHS plan core principles, I hope that he will at least be happy to accept what is proposed in amendment 6. I hope that sets the scene for this very important series of amendments.