Clause 2 — Duty to have regard to NHS Constitution

New Member – in the House of Commons at 8:30 pm on 12th October 2009.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 8:30 pm, 12th October 2009

I beg to move amendment 19, page 2, line 3, at end insert

'and the core principles of the NHS.

(1A) The core principles of the NHS are that-

(a) the NHS provides a comprehensive service, available to all;

(b) access to NHS services is based on clinical need, not an individual's ability to pay;

(c) the NHS aspires to the highest standards of excellence and professionalism;

(d) NHS services must reflect the needs and preferences of patients, their families and their carers;

(e) the NHS works across organisational boundaries and in partnership with other organisations in the interests of patients, local communities and the wider population;

(f) the NHS is committed to providing best value for taxpayers' money and the most effective, fair and sustainable use of finite resources; and

(g) the NHS is accountable to the public, communities and patients it serves.'.

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Photo of Sylvia Heal Sylvia Heal Deputy Speaker

With this it will be convenient to discuss the following: Amendment 15, page 3, line 6, clause 3, leave out subsection (2) and insert-

'(2) The Secretary of State must undertake a short review of the NHS Constitution within the first two years of operation and, thereafter, at least once in any period of 10 years the Secretary of State must carry out a full review (a "10 year review").'.

Amendment 20, page 4, line 9, clause 4, at end insert-

'(1A) The Secretary of State must revise the NHS Constitution in the light of relevant findings of the Care Quality Commission or the National Patient Safety Agency.'.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Sadly, because of the Government's raft of new amendments, we are rather pressed for time, so I shall be brief.

The purpose of amendment 19 is simple: it is to put the core principles of our NHS on to the statute book. As a concession to the Government, we offer them the core principles as they have most recently drafted them. The constitution itself has been not been considered by Parliament despite the fact that changes to it will be made by regulation, and it has been signed in a private ceremony by a Prime Minister who pledged to return power to Parliament. [ Interruption. ]

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Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. Will Members who are staying for this debate please keep the level of their conversations down?

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

If the amendment reflects only current rights, it cannot create a lawyer's charter, as the Minister will try to suggest. By having its provisions safely on the statute book, we would leave ourselves no Beano-reading hostages to fortune, as with the European fundamental charter of human rights. It would put our NHS on an ever-stronger footing. If Labour Members do not follow us through the Aye lobby, that will make a profound point about their opinion of the principles in the constitution, their opinion of the constitution itself, and, by extension, their opinion of and commitment to our NHS.

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Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

We are the party that introduced the NHS constitution. We certainly want to ensure that it sets out the guiding principles to the NHS, but not to turn it, as Mr. O'Brien appears to want to, into exactly what he referred to-a "lawyer's charter". I use exactly the same phrase as he did because that is precisely what we need to avoid. It is supposed to be a declaratory document, not a legal one. We need to ensure that the NHS is the area where this decision-making takes place, not the courts. Equally, if the NHS's principles were enshrined in primary legislation, that would rigidify and fix them in a way that meant that they could not be adapted as medicine and the NHS change. The result would be inflexibility in how the constitution develops.

We need to ensure that the NHS can move with the times and adapt when it needs to, and that it has the flexibility to develop its constitution in a way that responds to patients. The hon. Gentleman's proposal would prevent all that and ensure that the courts constantly intervened with detailed legal decisions. Difficult decisions that are currently made within the NHS would instead have to be referred to the courts by way of judicial review again and again. He knows, and I know, that issues related to the NHS can require difficult decisions. If we abrogate those decisions to the courts across the board, we will create substantial difficulties and delays.

Amendment 15, tabled by the hon. Members for Romsey (Sandra Gidley) and for Southport (Dr. Pugh), would require the Secretary of State to conduct a review of the NHS constitution within two years of its coming into effect. The constitution will be able to be examined constantly to ensure that it adapts. We will avoid the rigidity that the Conservative Front Benchers want, and we will be able to undertake the type of review that the hon. Member for Romsey wants, but we do not want to fix a review in time. We need to ensure that the NHS constitution can be kept under regular review-whether in two, three or four years. I therefore hope that she will not press her proposal.

Amendment 20, tabled by Dr. Taylor, would require the NHS constitution to be revised in the light of the findings of the Care Quality Commission and the National Patient Safety Agency. Although I commend the hon. Gentleman's intention and sentiment, the provision of high-quality care in a safe environment is at the heart of NHS values, and I am sure that we can agree that we want the NHS to deliver high-quality care across the board. The good work of the CQC and the NPSA helps to support that, and both will continue to play an important role as we move forward.

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Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I wish just to point out a deficiency in the NHS constitution. A whole set of duties are expressed in section 3b, but the duty to warn the NHS when something is going wrong, as in Staffordshire, is not there. The NPSA drew attention last week to the number of errors that have caused death in the NHS. I would like the Secretary of State to consider reviewing the constitution very soon and introducing a clause that brings in a duty to warn when things are going wrong, with protection for those blowing the whistle.

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Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

We certainly need to ensure that we do not have another Mid Staffordshire hospital situation and that the CQC, which has now replaced the Healthcare Commission, can produce reports on individual hospitals, receive references from individuals who feel that there are problems in particular trusts and act upon those references. I do not believe that we need to enshrine that in the constitution, but we do need to ensure that we can deal quickly with issues such as that at Mid Staffordshire.

In the Bill, we have ensured that unlike in the past, and unlike what recently happened in Mid Staffordshire, when a problem arises Ministers will have the ability to call upon Monitor to de-authorise a foundation trust, which will ensure that they can take action. We feel some sympathy with the hon. Gentleman's sentiments, but we believe that enshrining the matter in legislation in the way that he proposes is unnecessary. The involvement of the CQC and the NPSA will be important elements in the process.

In determining whether it is necessary to amend the constitution, we will consider a range of factors, including changes in departmental policy or the law. Patient safety and clinical quality are central to everything that the NHS does. The rights contained in the constitution already reflect that. We introduced the constitution and we want to ensure that it works. We do not want it to become a lawyer's charter. We want it to be effective and we want to ensure that the Government are the Government-and, indeed, the party-that protect and defend the NHS.

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Question put, That the amendment be made.

The House divided: Ayes 190, Noes 285.

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Division number 211 New Member — Clause 2 — Duty to have regard to NHS Constitution

Aye: 190 MPs

No: 285 MPs

Ayes: A-Z by last name


Nos: A-Z by last name


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Question accordingly negatived.

Proceedings interrupted (Programme Order, 8 June)

The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time ( Standing Order No. 83E).

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