Clause 297 - Commencement
Health and Social Care (Re-Committed) Bill
6:45 pm
Liz Kendall (Leicester West, Labour)
Clause 297 is the commencement clause that will enable the Bill, if passed, to come into force. I will explain why we intend to vote against the clause: we do not want the Bill to come into force.
Roger Gale (North Thanet, Conservative)
Order. Can we settle down, please? Stop chirruping for the last 15 minutes.
Fiona O'Donnell (East Lothian, Labour)
Thank you, Mr Gale. I am most appreciative. Does my hon. Friend agree that the most worrying thing that we have heard from the Government Benches today is the phrase “liberating the NHS”? The last time that the Government used “liberating” was in the Postal Services Bill, when they were selling off and privatising Royal Mail.
Liz Kendall (Leicester West, Labour)
My hon. Friend is precisely right. The reason why there has been such anger, outrage and opposition to this Government’s Bill is that people do not trust the Conservatives on the NHS. From now on, neither will they trust the Liberal Democrats. When will the hon. Member for Southport and the Minister’s friends in the other place actually do the job that they should have been doing if they had the principles of the NHS at heart?
One reason why we do not want the Bill to pass is that we have not been able to scrutinise the Government’s intentions properly. The Minister shakes his head. We did not get to discuss the clauses that will allow GPs to give themselves bonuses. We were not allowed to discuss the clauses that the Government say will deal with conflicts of interest.
More important, I do not believe that it is just about what we in the Committee do to scrutinise the Bill; crucially, it is about what patient, professional and other organisations do. I point out that earlier this week, we finally got the evidence from Monitor about its role, but we had finished discussing the changes to its role the week before. Today, at 4.30, we got evidence from the Royal College of Physicians, which represents hospital doctors in this country and has serious concerns. The first involves the Government’s proposal that the secondary care doctor on the board of the new clinical commissioning group must come from an outside area. The Royal College of Physicians says:
“We do not support the assertion that the secondary care specialist on the clinical commissioning group board must not be employed by a local provider.”
It asks for much greater clarification of how European procurement and competition law will apply and proposes far greater and more robust mechanisms for ensuring that secondary care is involved in health and well-being boards, health and well-being strategies and so on. It is not just for us in the House to scrutinise the Bill; we must allow professional bodies, patient groups and others to have their say. Due to the rush with which the Bill has been pushed through, they have not had the chance to do so.
Mr Burns indicated dissent.
Liz Kendall (Leicester West, Labour)
The Minister shakes his head, but, in the spirit of constructive help, I must tell him that he would have done better to give more time to the Bill, because it will jump back and bite him.
Owen Smith (Pontypridd, Labour)
Does my hon. Friend agree that the Royal College of Physicians submitting evidence today, a fortnight after its president said in evidence to the Committee that he had not had time to read the clauses, is the most telling example of what we have said throughout our proceedings? For us and for people outside who care about the NHS, there has not been enough time to scrutinise this crucial Bill.
Roger Gale (North Thanet, Conservative)
Order. I gently remind the Opposition Front-Bench team that the clause is about the commencement of the Bill. The hon. Member for Leicester West is being very creative, as she is entitled to be, but she should not overstep the mark.
Liz Kendall (Leicester West, Labour)
I would never overstep the mark, Mr Gale. I want to explain why I do not think that the Bill should commence, and one reason is that external organisations have not had time to examine it properly.
Kevin Barron (Rother Valley, Labour)
As my hon. Friend will see, the first line of subsection (1) states:
“The following provisions come into force on the day on which this Act is passed”.
Would she like to speculate on when that is likely to be, given that we are sitting here for a second Committee stage? Is there any possibility that it will happen next year? Could we be back here again?
Liz Kendall (Leicester West, Labour)
I am sure that Members in another place will look at the Bill, and at the Government new clauses and amendments that we have been unable to scrutinise. They will see that external bodies are submitting evidence at half-past 4 on the final day of the Committee, and they will conclude that they need to take a long time to scrutinise it properly.
Grahame Morris (Easington, Labour)
It seems that day by day and hour by hour, new information that is relevant to the Committee is leaked, and we get it second hand. Information has just been made available, for example, about the clustering of the strategic health authorities into four clusters from 10 clusters. We did not even have the opportunity to discuss clause 28 on the abolition of the strategic health authorities, yet this information is now in the public domain, even though it was withheld from the Committee. It is outrageous.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
On a point of order, Mr Gale. Will you advise the Committee about the effect of the Committee not approving the commencement clause, in the event that the Government lose the vote? Will it not effectively mean that the Bill will be implemented straight away on enactment?
Roger Gale (North Thanet, Conservative)
It is not up to the Chair to determine the policy of the Opposition or that of the Government. I believe that the Minister may be correct, but to date, I have had no indication that the Opposition intend to oppose the clause.
Liz Kendall (Leicester West, Labour)
My hon. Friend the Member for Easington raised the issue of the clustering of SHAs, and he made a point that I will come on to next, which is the reason why we do not want the Bill to pass.
Let us be honest about what has happened here. There has been a massive, top-down reorganisation, causing chaos and confusion in the NHS. The Government, including the Liberal Democrats, have forced a restructuring on to people, which they promised they would not do. If Members have spoken to anyone in their primary care trusts or strategic health authorities, or people in our hospitals who are trying to get changes through, or anyone in the service, they will know that the Government’s plans have caused a huge problem.
What will the result be for patients, who, after all, are what Opposition Members believe in? Last week, we heard that, despite the Prime Minister’s promise to keep control of waiting times, there are four times as many people waiting more than six weeks for their diagnostic tests than at this time last year. There are 10 times more people waiting more than three months, and only yesterday, we heard that 18-week waits are up by a third compared with May last year. Waiting times are also higher than the year-to-year figures from April to April, which were up 24%.
The point, as Nigel Edwards rightly states in today’s The Guardian—[Interruption.] Government Members involved Nigel Edwards in their Future Forum listening programme, so perhaps they would like to listen again. He said that
“there has been an obsession with major structural and upheaval change in the NHS in spite of the well-known fact that restructuring loses at least two years of progress.”
Nick de Bois (Enfield North, Conservative)
I have thoroughly enjoyed listening to the hon. Lady throughout the Committee’s deliberations, but I remind her that she is using the Future Forum rather selectively. She should remember that there was overwhelming support. Professor Field himself said, “Let’s just get on with it.” May that be the final word.
Liz Kendall (Leicester West, Labour)
It will not be the final word because Opposition Members do not want the Bill to proceed, and let me make it clear why. The Secretary of State and the Prime Minister like to say that the choice is between change and no change. They are wrong. The choice is between the right change and the wrong change, and the Bill proposes the wrong change. If Government Members have not picked up on that yet, let me explain why.
We know that the NHS needs to change to deliver better care for people with long-term chronic conditions and for an ageing population. The NHS also needs to centralise some services in specialist centres so that patients benefit from technological advances and from the enhanced skills of clinicians. The problem with the Government’s approach is that it will help us to achieve neither of those goals; in fact it is likely to make those goals harder to achieve.
The one case of strategic planning that has helped to improve stroke services in London was led by the strategic health authority. I think that the strategic health authorities became too large and should have been reduced, but getting rid of that strategic planning means that we will not be able to repeat the changes that have been achieved in stroke and trauma care.
Daniel Poulter (Central Suffolk and North Ipswich, Conservative)
The hon. Lady will accept, and we would agree, that one of the key problems in the NHS, as we heard from the witnesses, is that there is too much silo working. The King’s Fund has clearly elaborated in its recent report on silo working among GPs, saying that it does not tackle health care inequalities or the issues involved in dealing with an ageing population. Clearly, the current system does not work very well. The reforms are about tackling issues such as medical comorbidities by putting commissioning in one place, mostly in primary care. That will help to address the problem of an ageing population because there will be co-ordinated thinking and joined-up care.
Liz Kendall (Leicester West, Labour)
The hon. Gentleman is wrong if he thinks that commissioning is in one place. Let me explain to him his own Government’s Bill. There are clinical commissioning groups, clinical senates, clinical networks, health and well-being boards, a National Quality Board and an NHS commissioning bard. NICE has a role, too. That is chaos and confusion. If the hon. Gentleman does not believe me, perhaps he should listen to the evidence submitted today by the Royal College of Physicians. It said:
“The potential complexity introduced by the new system of bodies with advisory roles…delivery functions…oversight responsibilities…and regulatory and performance management responsibilities…must be minimised… there must be clarity on how reconfiguration decisions will be made in practice. The respective roles of clinical commissioning groups, clinical senates, scrutiny committees, Health and Wellbeing Boards, Monitor and the NHS Commissioning Board must be clarified.”
If the body representing hospital doctors, which the hon. Gentleman is himself, says that it is unclear who is responsible and how the changes will be made, the honourable Gentleman should not support the Bill.
Grahame Morris (Easington, Labour)
On that theme, will my hon. Friend comment on the analysis of Professor Sir Roger Boyle, the heart tsar? He is an eminent doctor and is responsible for driving incredible improvements in outcomes. What is his view on the reforms? Why is he taking early retirement?
Liz Kendall (Leicester West, Labour)
Professor Boyle thinks that the reforms are introducing waste, chaos and confusion. They take money away from front-line patient care. The extra bodies make it unclear who is responsible for leading changes.
Government Members shake their heads and look blank, but they will see in the months and years to come that patient care will go backwards under the Government’s plans. Whatever they claim, the heart of their Bill remains the same. There are 12 clauses on competition law, which is being introduced in the NHS for the first time, but there are no amendments, no changes to those clauses and the Minister has not explained why the Government are bothering to introduce them.