Thank you, Mr Hancock. I apologise to the Committee that, sadly, they have the monkey rather than the organ grinder. That is simply due to pressure of work, both in this Committee and on the Floor of the House, where there is an urgent question on Southern Cross. I apologise that the Committee is not being addressed by my fellow Minister, my hon. Friend the Member for Sutton and Cheam, but I will seek to do my best to fill his shoes for the rest of the debate.
As you will remember, Mr Hancock, when the Committee broke for lunch my hon. Friend was responding to a number of questions raised by Opposition Members. Before I discuss the main theme of the clause, I will continue to answer those questions. My hon. Friend had just answered points raised by the hon. Member for Oldham East and Saddleworth, regarding funding and conspiracy theories. I will respond to three further assertions she made, before going on to answer points raised by the hon. Member for Leicester West, the right hon. Member for Rother Valley and the hon. Member for Middlesbrough South and East Cleveland.
First, the hon. Member for Oldham East and Saddleworth asserted that the NHS is an incredibly efficient service. Although I agree that the NHS is incredible in a wide range of ways, I have to remind the Committee that productivity in the NHS, as measured by the Office for National Statistics, declined by an average 0.2% per year from 1997.
I am grateful to the Minister, and we are glad to see him take his rightful place. The most up-to-date comparison of health services across the western developed world was conducted by the Commonwealth Fund. It found that the NHS delivered one of the most effective and efficient services, particularly due to the GP gatekeeper role. Has the Minister read that report and does he agree?
I am particularly pleased that the hon. Lady asked me that. I have read the report, because I had the privilege of going to Washington in November last year in the place of my right hon. Friend the Secretary of State to give a speech to the Commonwealth Fund when it launched that report. I am very familiar with the report, because the following day we had a conference that I chaired on the subject.
I do not know if that was a diversionary tactic, but it will not take me away from the main point that I was making in response to the hon. Member for Oldham East and Saddleworth, which was that, on the basis of figures from the ONS and not from Conservative campaign headquarters, since 1997 productivity in the NHS has fallen each year by 0.2%. We are working hard to support the NHS to reverse that worrying trend.
The hon. Lady tried to assert that patient choice and any qualified provider would inevitably lead to financial meltdown. Again, I have to remind the Committee that it was the previous Labour Government who introduced choice of any hospital for elective treatment. Patients have been able to choose to be treated in any private hospital since 2007 and 200,000 patients a year do so; so far, that has resulted in neither financial meltdown nor service closure. Let me tell her, in the nicest possible way, that if that procedure and methodology for treating NHS patients free at the point of use was acceptable under a Labour Government, it is equally acceptable under a Conservative coalition Government.
If my memory serves me correctly, the hon. Lady repeated her Front-Bench colleagues’ claims that the Bill ushers in privatisation of the NHS. My fellow Minister of State, my hon. Friend the Member for Sutton and Cheam, made a series of excellent points about that this morning. All that I can add is a quote from another supporter of private sector involvement in the NHS, the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown), who told the Liaison Committee in 2007:
“The role of the private sector in the areas that you are suggesting is expanding, will continue to expand and will be a lot bigger in the next few years than it is now.”
I vividly remember the hon. Lady’s comments on the subject, not least because I was, rather hurtfully, reprimanded during them by my hon. Friend the Whip. To be frank, it saddens me that Opposition Members seek to misrepresent these issues and scaremonger among members of the public.
I do not disagree with what the Minister said about what happened in the past, but the question the Opposition have consistently posed is why we need all this competition law laid down in statute when, as the Minister says, we have been able to use the independent sector on many occasions for many years? Why do we need all this competition law?
The right hon. Gentleman must be patient. As I said at the beginning, I am coming to his comments and those of the hon. Member for Oldham East and Saddleworth. However, it is only fair that he does not queue-jump and that she has the opportunity to have the benefit of my views on her remarks.
I must tell the hon. Lady that it saddens me that people seek, for party political gain, to misrepresent the issues and scaremonger about Conservatives’ intentions towards the health service. There is no difference between the two of us in terms of our commitment to a national health service that is based on the principle of its being free at the point of use for those eligible to use it. I will bow to no one in my support of Nye Bevan’s founding principles of the NHS.
If we look at the years between 1945 and 1997, Conservative Governments were in office for a longer time than Labour Governments, but at no time did we seek, in any shape or form, to privatise the NHS. I do not want to be controversial or to rev up the Opposition, but those who remember their history will know that it was not a Conservative Government who introduced dental charges or prescription charges in 1950. The Opposition and the Government differ on how the NHS should be made more responsive to patients and more effective in delivering patient care and improving outcomes, but it is disingenuous to question the sincerity of our belief in the core principles of the NHS.
Debbie Abrahams (Oldham East and Saddleworth) (Lab) rose—
I am grateful to hear the Minister’s statement about how committed he is to the NHS, which reflects what those on both sides of the Committee want to achieve. If that is the case, I am sure that he will be able to withdraw the proposals in the Bill that deal with competition. That was the argument that I put forward: why have them? He is setting up the NHS to fail through these measures, so he should just withdraw them.
The hon. Lady, in the nicest possible way, has spoilt it. We were getting along so well until she tried to tempt me down a path along which I am not prepared to go. The short answer to her question is: because although we are totally committed to the same core principles, there is a chasm of difference between us on how to improve and enhance patient care and outcomes and put patients at the centre of the patient experience. The Government are doing it as laid out in the Bill, because we passionately believe that within the core principles it will improve and enhance the delivery of health care. The hon. Lady, from a perfectly respectable position, strongly disagrees. To put it crudely, however, we got the votes.
The hon. Member for Middlesbrough South and East Cleveland asked about quality and why it was not mentioned in relation to the regulations that these clauses introduce. The answer is that quality does not need to be mentioned in this clause. The regulations and related guidance will be clear, as the primary care trust procurement guide is clear now, that quality is a key consideration in tendering clinical services. Speaking about the Bill as a whole, the hon. Gentleman is well aware that it gives a definition of quality in primary legislation for the first time. Indeed, quality runs through the Bill in a way never previously seen in a piece of health legislation. I hope that my hon. Friends and the Opposition can agree with me on that point.
Finally, but not least, the hon. Member for Leicester West and the right hon. Member for Rother Valley asked specific questions about competitive tendering, and I am pleased to be able to provide further details on that point. The intention is that regulations under clause 67 could impose requirements governing the process of tendering for NHS services. To avoid that, it is not the Government’s intention under clause 67 for regulations to impose compulsory competitive tendering requirements on commissioners, or for Monitor to have powers to impose such requirements.
One concern that has been raised with me over the question of tendering is the frequency with which people will be required to tender. Will the Minister comment on whether services will be required to be tendered annually, biannually, or every three or four years? Some people believe that frequent tendering might lead to inefficiency and excessive work.
I am grateful to my hon. Friend for giving me the opportunity to clarify the situation and, I hope, to reassure him. This will also be relevant to the hon. Lady, given that she and her right hon. Friend have raised the matter. I can tell my hon. Friend that no, we do not intend to use the power comprehensively in that way. The purpose of the regulations will be to ensure that the commissioning board and the CCGs respect good practice and protect patient choice, and that they do not restrict competition to the detriment of patients. In some cases that would mean competitive tendering, but in others it might be in the interests of patients for commissioners to restrict competition, for example in specialised surgery or critical care networks. Ultimately, it will be for commissioners to decide which services to tender. We do not anticipate that time scales will be laid down stating that it has to be done every six months or every 12 months, for example. The system will respond to the needs of local commissioners in the areas. I hope that helps my hon. Friend.
I began, before that intervention, to say that—to avoid any doubt—it is not the Government’s intention that under clause 67 regulations would impose compulsory competitive tendering requirements on commissioners, or for Monitor to have powers to impose such requirements. We are talking about competitive tendering for clinical services funded by the NHS for patient diagnosis, care and treatment, just as happens now.
May I finish? This may satisfy the right hon. Gentleman, so that we can make some progress. There are already rules now, such as the PCT procurement guide, first published by the previous Government. Procurement law already applies to the NHS funding clinical services, and the Bill does not change that. The intention is that the regulations made under clause 67 will reflect the current rules.
I hope I have answered the points raised by hon. Members. I would now like to make a number of general points regarding the clause, before urging the Committee to support clause 67 stand part of the Bill.
The clause permits the Secretary of State to regulate the procurement practices of the commissioning board and commissioning consortia to ensure that they adhere to good practice in procurement, protect and promote patient choice and do not engage in anti-competitive behaviour against patients’ interests. Such regulations may include requirements to manage conflicts between commissioners’ interests in commissioning services and their interests in providing them. For example, some GPs might be in a position to provide the services that they commission through their clinical commissioning group. While they might be the best provider for a particular patient, we want to ensure that patients are given the choice of provider and that alternative providers are given a fair chance in providing the service.
The clause also states that regulations may include requirements relating to good practice in competitive tendering. We want to ensure that poor procurement practice, such as excluding bidders unfairly, can be prevented. That will not impose additional burdens on commissioners, nor is the requirement to comply with procurement law and best practice new. The Secretary of State already issues guidance on that—the PCT procurement guide, for example—with which PCTs are expected to comply and which was introduced by the previous Government. I hope that, with those explanations, hon. Friends will join me in ensuring that the clause stand part of the Bill.
I mentioned earlier the criteria for competitive tendering. Are we to assume that it will be based on quality and not on price?
I am not sure that the right hon. Gentleman will appreciate this reference to the early Blair years, but I want to go a third way: it will be based on value.