Care Bill [Lords]

Emma Lewell-Buck Excerpts

Tuesday 11th March 2014 Commons Chamber

[Steve Baker]

I am extremely grateful to the Minister for that reassurance because in my constituency there is really only one story: the loss of services, and, because of the way the clause has been presented by Labour Members, people are worried about that.

It has been said that these hospitals are categorically different because they exist in a broader health economy, but that is not why they are different. Any business exists as part of a wider economy with dependencies and so on—the hon. Member for Lewisham West and Penge (Jim Dowd) suggested the example of Comet versus Currys. In private enterprise, if the administrator turned up and shut down our competitors when we failed, it would obviously be absurd, but the truth is that both sides of the House have made a positive decision to use the techniques of state socialism to provide health care. That choice has consequences, one of which is this clause.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It will come as no surprise that I support the proposal to remove clause 119 from the Bill. Of all reforms in the Bill, this clause has attracted the most attention from my constituents. They recognise it for what it is—a frightening power grab by central Government that will put services across the whole country at risk from the Secretary of State. It is a cynical move from the Government, who in their wildly unpopular top-down reorganisation of our beloved NHS claimed that they wanted to put more power in the hands of doctors. Now they seek to give sweeping new powers to the Secretary of State.

It is of course true that some NHS trusts and foundation trusts find themselves in tough financial situations, and in those difficult situations decisions will have to be made so that services continue to operate. That is what the TSA regime was set up to do, and it is an appropriate process for dealing with the difficulties within a trust. It is true that trusts do not operate in complete isolation, but the TSA is already required to act with the interests of the wider health service in mind.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend is right when she says that the Secretary of State wants the power to privatise—I will be brutal about it—NHS services. We must recall—this is why we cannot believe the Minister or the Secretary of State—that before and during the general election, the Prime Minister said that there would be no top-down reorganisation of the national health service—[Interruption.]

[Mr Cunningham]

I am sure my hon. Friend will agree that the changes the Government want to make are in order to privatise the national health service through the back door. That is why the Secretary of State wants that power. Equally, we cannot believe the Secretary of State because, during the general election, the Prime Minister said that there would be no major changes to the national health service, and no top-down reorganisation. Why should we believe this lot now?

[Mrs Lewell-Buck]

I could not agree more with my hon. Friend.

TSAs can consider the impact on neighbouring authorities when making their recommendations, but they cannot and should not reconfigure services in well-performing trusts. Well-run trusts can and do collaborate with their neighbours, and play a role in reconfiguring services to help to achieve financial stability, but that must be voluntary. It is wrong for the Government to act through TSAs to reconfigure services in well-run trusts, and to do so against the wishes of local people and clinicians. It is also wrong that the opinions of health care professionals should be overruled by financial concerns, especially when the decisions being made affect trusts that are not at financial risk. That undermines the ability of health care professionals to act in the interests of their public.

The Government’s defence of the proposal is that clause 119 is a clarification of existing law, and yet the amendment was tabled in the other place while the Government’s appeal over the downgrading of services at Lewisham was still being considered. Surely it is the role of the courts to interpret and therefore clarify the law. It is more likely that the Government anticipated that their appeal would be rejected, as it was, and acted to expand the powers of TSAs so that reconfigurations such as that proposed for Lewisham could go ahead in future. I want to be clear: when any Government amends legislation so that it can be interpreted differently in the courts, they are not clarifying things but changing them.

[Paul Burstow]

I take the hon. Lady’s general point and understand why she is making it, but yesterday we debated new clause 11, which would have made clear a mistake that hon. Members on both sides of the House believe the courts made on the applicability of human rights legislation to social care that is publicly provided within private institutions. In that instance, we were not changing the law, but trying to ensure that the courts interpreted it correctly in the first place. There are instances when we do that.

[Mrs Lewell-Buck]

I agree with the right hon. Gentleman, but I do not believe it applies to clause 119.

My constituents are not especially concerned by the technicalities of legislation. The letters and e-mails I receive show concern with the practicalities of clause 119. People tell me that they fear for local services because, as more trusts fall into financial difficulties—more than 30 are reported to be in serious danger of doing so—the Secretary of State’s power will spread over a wide region. Perhaps the trusts that those people or their relatives use will not have a TSA appointed, but it is likely that services in their area will collaborate with trusts that do have one appointed. That makes them a target.

If the heroic efforts of the people of Lewisham and my hon. Friends are anything to go by, public concern will quickly turn to public outrage and protest if clause 119 makes it to the statute book. Lewisham has shown the Government the strength of opposition they can expect when they attempt to force unpopular reconfigurations on local communities. It is difficult to understand why they propose using that model throughout the country, but it appears that that is their intention.

I am concerned that, by taking that approach and using the TSA regime for a purpose for which it was never intended, the Government will make it more difficult to have a level-headed discussion on meeting financial challenges. We need a mature debate on how to adapt services to improve sustainability, but clause 119 will lead to pitched battles up and down the country over the closure of individual departments. The clause has attracted more controversy than any other in the Bill, and with good reason. It ignores the will of clinicians and the communities they serve. It puts at risk services in every corner of the UK. The Government must change course now.

[Karen Lumley (Redditch) (Con)]

I shall make a short contribution on clause 119. I agree with the principle behind the clause and the Bill, but we must ensure that the NHS can operate properly and efficiently, and provide our constituents with the care they deserve. My hon. Friend the Minister and my right hon. Friend the Secretary of State know very well of the review in Worcestershire in the past two years. My hospital—the Alexandra—has been in the spotlight. We have fought long and hard to retain services locally. I pay tribute to the tireless campaigners who, like me, are desperate to keep our services. Finally, we have seen a clinical solution to the problem. We all welcome that in Redditch, but it is not the end of the story—I wish it were.

--- Later in debate ---

[Mrs Lewell-Buck]

I shall be brief. Throughout the passage of the Bill, I have felt that there is considerable consensus on what a good social care system should look like. For that reason, I am disappointed that the Government failed to be more accommodating towards a number of reasonable amendments tabled by the Opposition. In particular, I still cannot understand the Government’s decision to remove the CQC’s duty to inspect commissioning, which stood as part of the original Bill and mysteriously disappeared when it was in the Lords.

There are worse elements of the Bill, such as clause 119. We heard earlier that this is a grave threat to every hospital and community in our country. Members on the Government Benches supported the clause today, but I expect most of them will regret doing so at some point in the future. Yet again, this has been a sad day for our health service on this Government’s watch. Underpinning everything we have discussed in the many hours of debate on the Bill is the fact that local authorities all over the country are experiencing a funding crisis, driven by a Government who appear unconcerned about the effects of their spending cuts on the poor and the vulnerable. Even the sensible reforms in the Bill will not benefit everybody.

I shall end on this point. Those people who are seeing their care packages disappear, those who are locked out of the care system, and everyone who turns up at a hospital to find that departments are shut—let them know that it is this coalition’s fault. I hope all coalition members are proud of themselves.