Oral Answers to Questions

Debate between Dan Poulter and Liz Kendall

Monday 12th May 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Before I turn to the amendments, I want to put on record my thanks to hon. Members for their contributions to today’s debate. I also want to express my thanks once again for all the contributions made by hon. and right hon. Members throughout the passage of the Care Bill and, indeed, for the contributions made by noble Members of the other place.

The hon. Member for Lewisham East (Heidi Alexander) made a characteristically robust contribution in standing up for her local health care services. I also pay tribute once again to the contribution made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), not only today, but at the Bill’s inception, during its scrutiny by the Joint Committee and throughout its passage through this House and the other place. He has done a tremendous amount of work to ensure that the Bill is much better than it used to be. He deserves considerable praise for what he has done and the help he has given the Government in securing a Bill that is not just fit for purpose, but which will make significant changes and improvements to our health care system.

It is worth bearing in mind that the Bill represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support for the first time. The Bill will also put a limit on the amount that anyone will have to pay towards the costs of their care. It is a very big step forward and one that was long overdue. The Bill also delivers key elements of this Government’s response to the terrible events that took place in Mid Staffordshire and the recommendations of the Francis report by increasing transparency and openness and helping to drive up the quality of care across our NHS and social care system. I am pleased that the Government were able to table amendments that have been accepted in the other place, and I hope that those amendments will enjoy support in this House today.

Before I turn to the substantive amendments tabled by the hon. Member for Copeland (Mr Reed), I want briefly to address the points made about human rights legislation and the issue of direct payments. It is important to highlight that like clause 48 of the Bill, as originally drafted, and section 145 of the Health and Social Care Act 2008, which was the preceding provision, Lords amendment 11B relates to providers of social care registered with the Care Quality Commission, covering personal care provided at home and in residential care settings. The amendment covers physical assistance—for example, prompting someone to take their medication, dress, eat, drink and perform activities of daily living—but not non-personal care. To answer the question asked by my right hon. Friend the Member for Sutton and Cheam, I am happy to confirm that when self-funders start to receive support from the local authority, they will indeed be covered by the Human Rights Act 1998.

To turn to the amendments tabled by the hon. Member for Copeland, it is worth highlighting to the House that, contrary to what he asserted, the TSA regime—let us remember that the regime was laid down by the previous Labour Government—has been substantively improved by the amendments made to the Bill. In particular, clause 118, which has been debated as clause 119 at various points, will extend the requirements on the trust special administrator to consult not just the public, staff of the failing trust and its commissioners, but other provider trusts, their staff and their commissioners, local authorities and local healthwatch organisations. There is therefore a comprehensive duty of consultation and engagement in the TSA regime, and that will be further strengthened by the amendments we are now discussing.

Amendment (a) to Lords amendment 40B and amendment (c) to Lords 40C amount to wrecking amendments and, as I shall outline, amendment (b) to Lords amendment 40B is unnecessary and unworkable. Amendment (a) to Lords amendment 40B and amendment (c) to Lords 40C would mean that the recommendations of a trust special administrator could not restrict access to any services of another affected trust. Like previous ones, they are in effect wrecking amendments that would make it impossible for the administrator to do their job.

Both Houses recognise that the NHS is a network and that no hospital is an island, and have already agreed that clause 118 must allow the administrator to take a holistic view of the local health and care economy to find the very best solution for a failing trust. That is of course in the best interests of local patients. As my right hon. Friend the Member for Sutton and Cheam outlined in Committee, it is right that a trust and its patients in particular are not thrown to the wolves when the quality of care is unsustainable or letting patients down, but that a holistic and broader view of the local health care economy can be taken. That was the previous Government’s intention in setting up the TSA regime, and it is our intention now. The previous Government were not the first Government who did not necessarily make their legislation accord perfectly with the intentions they outlined in impact assessments for the TSA regime. That is why we are now in the position of having to correct and improve the regime through the Bill.

The amendments tabled by the hon. Member for Copeland would undo the effects in relation to the trust special administrator’s regard to the wider health economy, and they would reverse the effect of clause 118, such that the administration regime would not be able to create a complete and workable solution to intractable problems or failures of patient care in the NHS. I am sure hon. Members will agree that that would be entirely undesirable, and that it would not be in the best interests of NHS patients, who must be protected where a hospital cannot deliver safe or sustainable care.

Amendment (b) to Lords amendment 40B would give the trust special administrator significantly less time to finalise his or her draft recommendations about the future of a failing trust by requiring the publication of all correspondence between the administrator and commissioners at least 10 working days before publication of the draft report. Hon. Members will be aware that we have extended the time for the trust special administrator to draw up the report from 45 to 65 days and for the consultation from 30 to 40 days, because those processes need to be done properly.

I remind hon. Members that transparency is already built into such processes at every stage. The administrator is required to publish the draft report submitted to Monitor and is expected to include in it the commissioners’ statement in agreement or disagreement to the report. Following consultation, the administrator’s final report is submitted to Monitor for a decision. That report, which Monitor must publish and lay before Parliament, again needs to present to the regulator the views of all affected commissioners. The administrator is required to attach to the final report a summary of all responses to its draft report that were received during the statutory consultation. That would include the views of all affected commissioners as respondents and explain what consideration was given to those responses. There is full transparency at every stage of the process. Quite apart from being wrecking amendments, the Labour amendments are therefore completely unnecessary.

[Liz Kendall (Leicester West) (Lab)]

Wrecking amendments? They are saving you from yourselves!

[Dr Poulter]

The administrator, working closely with all affected commissioners and providers, may need to communicate in writing in the 10 working days before the draft report is published and submitted. Amendment (b) would therefore significantly reduce the time available to the administrator to develop and finalise the draft report and seek commissioners’ agreement. The hon. Member for Copeland said that he was concerned about that process, but his amendment would make it more difficult.

Clause 118 will extend the time that is available to the TSA to develop the draft report. Amendment (b) would reverse that. That is irrational, undesirable and goes against the very point the hon. Member for Copeland made about having time to consider the best interests of commissioners and the local health economy. I thought that that was an unintended and unwanted consequence of the amendment, but having heard the comments of the hon. Member for Leicester West (Liz Kendall), I am not so sure. However, I hope that the hon. Gentleman will not press the amendments.

In conclusion, the Government are committed to a TSA regime that is workable, transparent and in the best interests of patients. In cases of exceptional and significant care failure, lives are put at risk if a problem is not dealt with swiftly and effectively. It is for that reason that we are strengthening the regime in the Bill. I am very proud of the Bill and the opportunity that it offers to improve the health of and, the quality of care for, many people, particularly the frail elderly, those with disabilities and those with long-term care needs. It represents the most important step forward in integrating and better joining together health and social care for well over a generation. I hope that hon. Friends and hon. Members will support the Bill and the amendments that have been made to it.

Question put and agreed to.

Lords amendments 11B and 11C in lieu of words left out by Commons amendment 11 agreed to..

Lords amendment 32A to Commons amendment 32 and consequential Lords amendments 32C and 32D agreed to.

Clause 118

Powers of administrator etc.

Amendment (a) proposed to Lords amendment 40B.—(Mr Jamie Reed.)

Question put, That the amendment be made.

Care Bill [Lords]

Debate between Dan Poulter and Liz Kendall

Tuesday 11th March 2014 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

We all want to see better, more integrated care, so why did Ministers not keep a closer eye on the cock-up that has been made with care.data?

[Dr Poulter]

It was very clear, as NHS England has acknowledged, that the communication exercise put forward was not ideal. That is part of the reason why we are debating the issue today. I hope I have brought further reassurance to hon. Members about the fact that the 2012 Act does put in place robust safeguards, which were not in place under the previous Labour Government. We have put in place the safeguards through that Act and through the Government amendments we have tabled.

Oral Answers to Questions

Debate between Dan Poulter and Liz Kendall

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that integrated care working, better intermediate care and ensuring that GPs work closely with accident and emergency departments are exactly the kind of factors, along with joining up health and social care, that take pressure off A and E departments. I am delighted that things are going so well in his local area.

[Liz Kendall (Leicester West) (Lab)]

Happy new year, Mr Speaker.

People want a care system that gets the best results for patients and one that makes the best use of taxpayers’ resources, but under this Government they are getting neither. Half a million fewer people are now getting social care services to help them to continue to live at home, and half a million more older people are being admitted as more expensive hospital emergency cases that could have been avoided. Will the Minister tell us how that record represents good care and good value for taxpayers’ money?

[Dr Poulter]

The point I made earlier is that the number of cases of bed blocking due to social care delays has decreased under this Government. Also, it was the previous Government who began to change the eligibility criteria. Labour Members talk about a crisis in social care, but per-head funding for social care fell in the last term of the previous Government. That is the legacy that we are dealing with, and we are sorting it out—

NHS England

Debate between Dan Poulter and Liz Kendall

Tuesday 10th December 2013 Ministerial Corrections

[Liz Kendall]

To ask the Secretary of State for Health what the (a) total budget, (b) total number of staff and (c) budget for staff salaries is for those employed by NHS England but not for NHS England local area teams.

[Official Report, 28 November 2013, Vol. 571, c. 415W.]

Letter of correction from Dan Poulter:

An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 28 November 2013.

The full answer given was as follows:

[Dr Poulter]

NHS England's total revenue budget for 2013-14 is £95.873 million, of which £2.016 million is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.

As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.

The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.

The correct answer should have been:

Oral Answers to Questions

Debate between Dan Poulter and Liz Kendall

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

My hon. Friend will be aware that this is a matter for local commissioners to decide and it is not for Whitehall to impose solutions on them. There are issues and efficiencies that Morecambe Bay trust can drive by better managing its estate and reducing temporary staffing costs. The hospital and trust will, of course, want to look into those issues in improving their financial outlook and the quality of care they can provide for patients.

[Liz Kendall (Leicester West) (Lab)]

Whatever the Minister claims, the reality is that the Secretary of State has lost grip of NHS finances just as he has lost grip of the crisis in A and E. Earlier this month, we learned that half of all NHS hospital trusts are now predicting deficits—up from one in 12 last year. As a self-proclaimed champion of openness, will the Minister now commit to publishing those deficit figures monthly and guarantee that all NHS acute trusts will balance their books by the end of the year? It is a simple question—yes or no.

[Dr Poulter]

The hon. Lady is being economical with the figures. I indicated earlier that 70% of trusts and 89% of foundation trusts are predicted either to break even or end the year with a financial surplus. That is hardly a difficult position. Those trusts that have deficits are often a direct legacy of the PFI deals negotiated by the previous Government and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. The sector as a whole is predicting £109 million of surplus. That is hardly a deficit. I know that the Labour party is not very good with figures and cannot add up, which is why this country is in such an economic mess, but the figures speak for themselves: £109 million of surplus is predicted for trusts and foundation trusts.

Oral Answers to Questions

Debate between Dan Poulter and Liz Kendall

Tuesday 16th April 2013 Commons Chamber

[Dr Poulter]

Surely the validity of evidence is a matter for the court. I am sure my hon. Friend would recognise that there has to be a distinction between what we do here in Parliament and what is done in the courts. If NHS England would like to appeal the decision and if it thinks there are good grounds to do that, it must do that. The decision will then ultimately be made in the courts, on the basis of how valid that appeal is.

[Liz Kendall (Leicester West) (Lab)]

The best way to improve outcomes for heart disease patients and get the best value for public money is to help people to manage their condition at home. Will the Minister therefore explain the thinking behind the Government’s strategy of cutting one in five district nurses, so that delayed discharges from hospital due specifically to a lack of NHS community services rise by 40%, costing taxpayers £6 million a month as a result?

[Dr Poulter]

The hon. Lady and Opposition Members are fond of saying that we are cutting the NHS. It is their party that has said it will cut; they think it is irresponsible to increase funding for the NHS. We on the Government Benches have invested £12.5 billion more in the NHS. There are 6,000 more clinical staff working on the ground, focusing specifically on early intervention, early strategies and lifestyle. We now have almost 1,000 more health visitors working in the NHS and we have expanded the family nurse partnership programme. All these things will make a difference. Indeed, there is now a lot more joint commissioning between hospitals and primary care, to ensure that commissioning arrangements are in place better to support the role of community nurses and district nurses in preventive care and better look after people with long-term conditions.

Oral Answers to Questions

Debate between Dan Poulter and Liz Kendall

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.

[Liz Kendall (Leicester West) (Lab)]

The Government say that the number of doctors in the NHS has increased by 5,000 since they came to power. When did those doctors start their training?

[Dr Poulter]

We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.

Adult Social Care

Debate between Dan Poulter and Liz Kendall

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.

Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.

We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.

A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.

I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?

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

One of the authors of the Dilnot report was Lord Warner, who was a member of the previous Labour Government. He made the point that one of the reasons for the funding crisis is that the previous Government failed to invest adequately in social care; it received only 70% of the funding compared with the NHS. That was one of the major failings of the previous Government. They should have invested more in social care when the sun was shining and the country had the finances to do that.

[Liz Kendall]

I politely say to the hon. Gentleman that we did not cut local council budgets by a third. I have always said that social care budgets have been under increasing pressure for many years, which is why we desperately need funding reform. I know that he supports that reform and will work with us in the years ahead.

The Government’s decision to kick the issue of long-term care funding into the long grass is a bitter blow for older and disabled people and their families. It is a huge disappointment for local councils, which are desperate for a new social care settlement, and it is a disaster for our NHS, which will face intolerable pressure as our care system crumbles further still. This issue will not go away, because our population is ageing. Our care system needs fundamental reform—reform this Government have so far failed to deliver. I commend the motion to the House.

Minister for Older People

Debate between Dan Poulter and Liz Kendall

Thursday 28th June 2012 Commons Chamber

[Liz Kendall]

I did say that social care budgets had been under increasing pressure for many years, but local councils are now facing cuts of a third in their overall budget. Adult social care is their biggest discretionary spend, so they face real challenges and are moving their criteria from modest to only substantial and critical need.

Preventive services have all but disappeared in many areas. Fewer older people get free care; more end up having to go into hospital, or are unnecessarily stuck in hospital or more expensive residential care. Charges are increasing across the country and vary hugely depending on where people live. It is not just older people who are suffering, but their families. Carers suffer ill health and some have to give up work because the right services are not available. There are costs to the taxpayer if they are not in work and contributing financially. There are also increased benefit bills.

The fundamental problem, and another reason why a Minister for older people is important, is that our welfare state was established in a very different age. In 1948, average life expectancy was 66 for men and 71 for women; now, it is more than 78 for men and 82 for women. Some health conditions that are now common amongst older people, such as dementia, were almost unknown back then, and many disabled children died at a young age. Social expectations were very different. Disabled adults had fewer rights, and people automatically assumed that women would stay at home to care for their families.

[Dr Poulter]

Will the hon. Lady give way?

[Liz Kendall]

I have a little more to get through, but I will take the hon. Gentleman’s intervention.

[Dr Poulter]

I am going to be supportive. The hon. Lady is making some good points. Does she agree that not only the welfare state was set up for a previous era, but also the NHS? It is a crisis-management system built around acute hospitals, and the challenge has to be to deliver more care in the community.

[Liz Kendall]

I thank the hon. Gentleman. I meant welfare state in its broadest sense, including the NHS. That is the big challenge for us. We have to make a fundamental shift in the focus of services—out of hospitals, into the community and towards prevention and early intervention to help keep people as fit and healthy as possible for as long as possible. Services need to be more joined up and personalised to meet individual needs.

The previous Government made big improvements. We backed integrated care, including care trusts such as the one I recently visited in Torbay, which has made huge progress. We invested £230 million in extra care housing projects, which have made a big difference in older people’s health and physical condition, and we introduced personal budgets and direct payments. I hope that this Government will build on many of those developments in their long awaited White Paper, but we shall not be able to tackle the care crisis unless we reform care funding.

Several Members have talked about the Dilnot commission, which represents the best opportunity in a generation to reform the way care is funded. It is an opportunity that politicians in all parties must grasp with both hands. We tried to get cross-party agreement on social care funding at the last election. We did not succeed, but we are determined to try again now. That is why my right hon. Friend the Leader of the Opposition initiated cross-party talks when Dilnot’s recommendations were published.

I am concerned about the fact that the Government have backtracked on their promise to legislate in this parliamentary Session for new legal and social frameworks for social care. The Queen’s Speech included only a draft Bill on reforming social care law. The Opposition want legislation on a new system for funding social care in this Parliament, and we are pressing for that in the cross-party talks, but that can only come about if there is commitment at the highest level—not just from a Minister or shadow Minister for older people, but from No. 10, No. 11 and other members of the Cabinet.

Our ageing population is something that we should celebrate. Older people make a huge contribution to their families and our society; I see that in my constituents’ lives, and in mine—as often as I get to see my parents. However, our society has barely begun to understand the implications of this vast demographic change. A Minister for older people would make a big difference, but it is incumbent on all politicians—local and national—across the spectrum to understand that we must work together to deliver a better, more dignified life for people, so that they can live a long, fulfilling life, and have more life to their years, as well as more years to their life.

Health and Social Care Bill

Debate between Dan Poulter and Liz Kendall

Tuesday 20th March 2012 Commons Chamber

[Liz Kendall]

No, I am going to proceed.

Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.

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

rose—

[Liz Kendall]

I am going to finish this point.

The Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), said that all and any changes to those provisions were “unnecessary”, and denied that there was any lack of effective governance. I would remind Liberal Democrat Members that the Minister argued that putting a board in place or dealing with conflicts of interest would mean that clinical commissioning groups would fail to be “liberated”. Those criticisms were among the many issues that were supposed to be dealt with when the Government embarked on their now infamous “pause” in the Bill’s progress last spring, but they were not. The Government were therefore forced to return to the issue in the other place. However, the amendments before us are still weak, incomplete and ineffective.

The Government say that clinical commissioning groups will have to include in their constitutions how they intend to manage conflicts of interest. However, I am afraid the Government are deluded if they think that the national NHS Commissioning Board will be able adequately to scrutinise whether hundreds of clinical commissioning groups are properly implementing the measures in thousands of contracts, particularly when the board has already taken on so many other huge responsibilities for managing the Government’s new system. Giving Monitor powers to scrutinise clinical commissioning groups is inadequate for the same reason. Saying that Monitor can deem a clinical commissioning group’s contract to be ineffective, if it thinks that conflicts of interest have not been dealt with, will in effect mean closing the stable door once the horse has bolted. Indeed, there could be huge problems on the ground, as a provider may have already started delivering services to NHS patients by the time Monitor takes its decision.

Labour’s Front-Bench team in the other place tabled a comprehensive amendment to deal with conflicts of interest in clinical commissioning groups. It would have ensured a code of conduct for how clinical commissioning groups register, manage and report on conflicts of interests among its members and employees, and imposed a duty on CCG members to abide by the code. The amendment would have ensured that no member of a clinical commissioning group could take part in discussion or decisions concerning any provider of services with which that person had a registrable interest, and allowed the Secretary of State to appoint an adjudicator to investigate complaints about any breaches of the code, with a range of financial and other sanctions available, including the ability to suspend or remove a person from the clinical commissioning group. However, the Government rejected that comprehensive amendment, saying that such sanctions were unnecessary.

The Government have agreed to Lords amendment 31, which at least says that there must be a register of interests for a group, along with its governing body, sub-committee and employees, and that the register must be kept up to date, with information updated within 28 days. That change is welcome, but it does not go anywhere near far enough in ensuring that conflicts of interest are robustly dealt with. That is why our amendment (a) to Lords amendment 31 would ensure that members of a clinical commissioning group would not be able to take part in discussions or decisions about services in which they had declared a registered interest, which is the same format as in local government.

Health and Social Care (Re-committed) Bill

Debate between Dan Poulter and Liz Kendall

Tuesday 6th September 2011 Commons Chamber

[Dr Poulter]

The right hon. Gentleman was a part of the party of Government at that time. Lord Warner was a leading member, and it is fair to point out that he has come forward with some good cross-party recommendations that we very much welcome. The recommendations point to the fact that the key challenge for the NHS is better integrating services and providing high-quality patient care, especially in elderly care and adult social care. That has not happened as effectively as it should have done in the last 10 years and we need to ensure that it does happen. That is why this Bill is a good thing.

Members on both sides of the House have generally welcomed the use of the private sector where it can add value to the NHS, especially for patients. That has to be a good thing, but we need to ensure—as the Bill does—that we do not have the cherry-picking that we saw in the past. We need to ensure that we have a health service that provides better value for money, better care and more integrated adult social care and health care for the frail elderly.

[Liz Kendall (Leicester West) (Lab)]

This is a crucial part of the debate that we will have over the next couple of days. Parts 3 and 4 of the Bill are at the heart of the Government’s proposals for the NHS and of the concerns that professional bodies, patient groups, members of the public and Members—at least on this side of the House—have about those proposals. These parts will introduce a new economic regulator for the NHS, modelled on the same lines as those for gas, electricity and railways. They also enshrine UK and EU competition law into primary legislation on the NHS for the first time.

We have also been discussing crucial new amendments that, despite what the Secretary of State says, have not been scrutinised by the Future Forum, about the Government’s new failure regime. That essentially addresses which local services and hospitals—such as we all have in our constituencies—will be allowed to fail.

Each of these subjects should be subject to separate and far longer debates, because they are of such importance to our constituents, our local NHS staff and our local services. However, because the House has been given so little time and the Government have tabled so many amendments, we have been forced to take these huge issues together—[Interruption.] As always, the Minister of State groans from a sedentary position, but Members have a right to question the Government on their proposals for local hospitals and services, and three or four hours is not sufficient. I hope that the other place will take that into account.

The Bill establishes Monitor as an economic regulator, modelled on the same lines as those for gas, electricity and railways. The explanatory notes make this explicit. Page 85 states that clauses in part 3 are based

“upon precedents from the utilities, rail and telecoms industries”.

Indeed, in an interview with The Times earlier this year, David Bennett, the new chairman of Monitor, confirmed that that was the Government’s plan, saying that Monitor’s role would be comparable with the regulators of the gas, electricity and telecoms markets.

Labour Members have consistently argued that such a model is entirely wrong for our NHS. People’s need for health care is not the same as their need for gas, water or telecoms. There is a fundamental difference between needs, ability to benefit, the complexity of services and the fact that they are far more interlinked. The NHS is not a normal market. It is not like a supermarket, or like gas or the railways. There are much more important issues at stake.

The Government have made some minor amendments to Monitor’s duties, but they will not ensure the integration and collaboration that many hon. Members recognise is vital to improving health, especially for patients with long-term and chronic conditions. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said, the duties still rig Monitor in favour of competition. It is not only Monitor’s duties that do that. Chapter 2 of part 3 contains 12 clauses that explicitly introduce competition law into primary legislation on the NHS for the first time. The clauses give Monitor sweeping powers to conduct investigations into NHS services; to disqualify senior staff in hospitals and other NHS services; and to impose penalties for breaches of competition law, including the power to fine services that are found to have broken the law up to 10% of their turnover. Not only that, but third parties, including competitors, can bring damage claims against those services.

The Government claim, as the Secretary of State did earlier, that somehow those provisions will not change anything. In that case, why bother to have the clauses in the Bill? As the hon. Member for Southport (John Pugh) said, Labour Members have argued not that the Bill extends the scope of competition law, but that it extends the applicability of competition law to the NHS. It is not just the clauses on Monitor and competition law that do this, but others such as those that abolish the private patient cap on foundation trusts, and other Government policies, such as that of “any qualified provider”.

NHS Reorganisation

Debate between Dan Poulter and Liz Kendall

Wednesday 16th March 2011 Commons Chamber

[Liz Kendall]

The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), also said yesterday, in the Health and Social Care Bill Committee, that EU competition law would apply, and gave me some assurances that that would somehow not change anything. When I asked whether the Government had taken legal advice on that, he admitted that they had. I asked him then to publish that advice so that hon. Members did not have to take my word for it, and I shall do so again. Will he publish that advice so that hon. Members can see whether GP-commissioning consortia and providers will be subject to EU competition law? Sadly, it appears that he will not do so.

[Dr Poulter]

If the hon. Lady is so concerned about competition and markets, why did the previous Government introduce Monitor, and why were they happy to pay the private sector 11% more than the NHS to provide NHS services?

[Liz Kendall]

I am sure the hon. Gentleman knows that Monitor was established as part of the regulation of foundation trusts. Removing that responsibility will mean that there will be no outside checks and balances on those trusts as there are now. Government Members should think seriously about that.

Our health and our NHS are not the same as gas, electricity or the railway. That the Secretary of State believes that they are shows how dangerously out of touch he is. What is the likely result? GPs will be forced to put local services out to tender even if they are delivering good quality care that patients choose and like; hospitals and community services will be pitted against one another when they should work together in patients’ interests; care, which as many hon. Members have said is vital as our population ages and there is an increase in long-term conditions, will become more and not less fragmented; the financial stability of local hospitals will be put at risk, and they will have no ability to manage the consequences of choice and competition in the system; and the whole system will be tied up in the costs of red tape, as GPs and hospitals employ an army of lawyers and accountants to sign contracts and fight the threat of legal challenge, huge fines and the potential of being sued. Let us also be clear that the Bill gives Monitor the same functions as the Office of Fair Trading, so it can fine organisations up to 10% of their turnover.

The more we see of the Bill, the more the truth becomes clear. The Secretary of State says that he wants clinicians to be more involved, and “no decision about me without me” for patients, but when the Royal College of General Practitioners, the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Midwives, the British Medical Association or anyone else tells him that he should stop, think again and halt his reckless NHS plans, he refuses to listen. When the Alzheimer’s Society, the Stroke Association and Rethink tell him that his proposals will not give patients a stronger voice and improve public accountability, he simply tells them that they are wrong. When health experts such as the King’s Fund warn that driving competition in every part of the NHS will make it more difficult to commission the services that best serve patients’ interests, he simply puts his fingers in his ears and walks away. What makes this Secretary of State think that he is right when professional bodies and patient groups know that he is wrong?

Doctors and nurses do not support the Government’s plan, patients do not want it, some Conservative Back Benchers and members of the Cabinet do not like it, and the Liberal Democrats hate it. They had the sense last Saturday to see what the hon. Member for St Ives (Andrew George) called the potential catastrophe as far as the future of the NHS is concerned, and to ask for amendments to the Bill. I hope they have the sense to join us in the Lobby tonight. I commend the motion to the House.