MPs Vote Through Controversial Health Bill

September 7, 2011

They gave their backing to the “third reading” of the Health and Social Care Bill which means it passes from the Commons to the Lords. The Government had feared a rebellion from Liberal Democrat MPs but instead won with a healthy majority of 65. Sky sources said four Lib Dems voted against the Government with up to 10 abstaining. The rebels are understood to be Julian Huppert, Greg Mulholland, Andrew George and Adrian Sanders.

A total of 316 MPs voted for the Coalition’s position, with 251 against. Labour have indicated they will still try to wreck the Bill in the House of Lords. They could have allies in senior Liberal Democrats. Baroness Williams has already signalled her concerns. After a second day of debate, Health Secretary Andrew Lansley told the Commons his “only motivation” was safeguarding the NHS. But critics, mainly on the Labour benches, said they feared the changes would see the NHS “destroyed”. Shadow health secretary John Healey called the reforms the wrong policy, based on the “wrong ideology”.

He warned the Bill would see power to direct the health service transferred from the Secretary of State to hundreds of devolved bodies. The change “betrays the founding principles” of the health service, he said. But Conservative MP Stephen Dorrell, who chairs the influential health committee, said the Bill had been substantially changed and improved. Earlier this year opposition to the reforms prompted the Government to “pause” its passage through Parliament to try to address concerns among the medical profession. Mr Dorrell said the new version was different in “important respects”. Mr Lansley’s flagship plans involve handing a commissioning budget worth £60bn to groups of local GPs. It will also see Primary Care Trusts scrapped, administration costs reduced and a bigger role for private sector providers.

Doctors’ Body: Withdraw ‘Risky’ NHS Reforms

September 2, 2011

Doctors’ leaders have called for the Government to withdraw or rewrite its NHS reforms, a move the Department of Health described as “disappointing”. British Medical Association chairman Dr Hamish Meldrum said the policy still posed an “unacceptably high risk to the NHS”. His intervention comes days before MPs return to the House of Commons and prepare to look again at the Health and Social Care Bill. The Government decided to put the policy on pause before the summer recess in the wake of widespread opposition to the proposals. In a letter sent to every MP, Dr Meldrum said: “It is clear that the troubled passage of the Health and Social Care Bill reflects real concern over the future direction of the health service in England.” Although the coalition Government has made an effort to address concerns, the BMA believes the changes threaten the health services’ ability to operate fairly and effectively.

“This is why the BMA continues to call for the Bill to be withdrawn or, at the very least, to be subject to further, significant amendment,” Dr Meldrum wrote. The body also warned not enough thought had been given to “unintended knock-on effects” from the reforms and fears the policy has been a “noticeable distraction” from the task of improving patient care. According to the letter: “The risks are high, not least because the long-term effects of the legislation are likely to be extensive. “Meaningful, sustainable reform needs to have the full confidence of patients and those working in the health service.” But a spokesman for the Department of Health rejected the concerns. “The BMA’s campaign is disappointing because, as the doctors’ union, they previously said they were pleased that the Government has accepted the Future Forum’s core recommendations, and that there will be significant revisions to the Health and Social Care Bill,” he said. “The independent NHS Future Forum confirmed the NHS must change to safeguard it for the future.

“They also found the principles of our plans – such as handing more power to doctors and nurses and putting patients at the heart of the health service – are well supported. “We will never privatise the NHS and patients will never have to pay for NHS care. “Our plans have been greatly strengthened in order to safeguard the future of the NHS,” he added. Since the Government began a “listening exercise” into health professionals’ fears about the policy, it has proposed more than 180 amendments to the bill. Several issues remain politically contentious and may face opposition in Parliament from some Liberal Democrats as well as Labour. Health Secretary Andrew Lansley wants to hand a £60bn commissioning budget to local consortia of GPs and cut a range of health bodies, including abolishing Primary Care Trusts.

Doctors turn to peers to block reforms

September 8, 2011

Doctors leaders have promised to lobby peers after MPs backed healthcare reforms. The Health and Social Care Bill had its third reading on Wednesday and passed with 316 votes for and 251 against. The BMA has expressed its disappointment but has pledged to fight on, highlighting its concerns as the bill enters the Lords. BMA GPs committee chair Laurence Buckman (pictured) said: ‘Although there has been a bit of movement in some areas, we’re disappointed that MPs didn’t grasp their final opportunity to make the sort of major amendments to the Health and Social Care Bill that we’d like to have seen. ‘However, it is not over yet — we know many of the lords share our concerns about this flawed bill and the BMA will be using every opportunity available in the coming months to make sure doctors’ concerns are heard.’

Legal question

Debate among MPs yesterday during the bill’s second day of report stage included arguments over whether altered language meant that the health secretary could ‘wash his hands’ of the NHS by not having the same legal responsibilities. The issue has been one of the BMA’s major concerns. Health minister Paul Burstow said the health secretary ‘will remain politically and legally accountable for a comprehensive health service’ and ‘will retain the capacity to intervene where necessary to ensure that a service is provided’. St Ives Liberal Democrat MP Andrew George — one of four Lib Dem MPs who rebelled against the coalition government and voted against the bill — sought clarity, arguing that past health acts included requirements on the health secretary to ‘provide or secure’ NHS services.

‘Critical change’ to duty

Pontypridd Labour MP Owen Smith also argued there was a ‘critical change’ which diluted the traditional duty to provide and secure and replaced it with a duty to ‘secure that services are provided’. However, an opposition amendment to insert the clause ‘the secretary of state must for that purpose provide or secure the provision of services’ was defeated by 304 votes to 255. All government amendments passed and opposition amendments were defeated. One opposition amendment called for a strengthening of the health secretary’s ‘duty’ to ‘maintain a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all staff delivering NHS services’.

Mr Burstow said an ‘explicit duty’ for the health secretary to maintain a system for professional education and training would be set out in a forthcoming government amendment during the Lords stages of the bill. MPs also debated the lines of accountability for directors of public health, which will be employed by local authorities, and the requirements expected of the NHS Commissioning Board and clinical commissioning groups. The BMA produced a Health and Social Care Commons Report Stage and Third Reading Briefing and a supplementary briefing on the government’s detailed amendments.

The NHS reforms still amount to privatisation

September 6, 2011

The health and social care bill returns to the House of Commons today. For all the political manoeuvrings of the listening exercise and the cosmetic changes, the bill remains a bad bill, and it fails the Nick Clegg test. Clegg’s stated view is that the following conditions must be met:

• GPs should not be forced into signing up to commissioning consortia

• The pace needs to be slowed

• All artificial deadlines need to be removed

• The NHS needs to be protected rather than undermined.

The amended bill does not meet any of Clegg’s demands: rather, it makes it worse.The core privatisation principle remains intact. Whether the deputy PM has been muzzled or he is keeping his powder dry for another assault is unclear. What is evident is that the prime minister remains doggedly behind his health secretary.

This reform by a knowledgeable but misdirected health secretary is unique in its messiness and incoherence. Most critics, from the left as well as the right, had hoped that the bill would effectively be scrapped and David Cameron would start from a clean slate. Instead, a tweaked bill has produced a far from satisfactory result. Cameron’s reassurance that the NHS is safe in Tory hands now seems hollow. To date, Andrew Lansley has failed to explain to the British public the need for this monumental change. Remember, a recent study in the Journal of the Royal Society of Medicine showed that the NHS is the most efficient service in the world, in lives saved per pound spent. How has David Cameron allowed this to happen? The public should have no illusions: beneath the veneer of the listening exercise, the core substance that constitutes the bill remains contentious.

The NHS reforms remain driven by pure market ideology, without a shred of evidence that they will benefit the English population. On the contrary, the evidence shows that if you create an American-style healthcare system the result will be denial of care and huge costs for the taxpayer. If the bill is passed, coming generations will not forgive us for taking the “National” out of the NHS. Financial pressures, flat budgets until 2015 and an ongoing £20bn savings drive mean that at least 20 to 30 hospitals (10% of hospitals in England) are facing bankcruptcy in their current form and soon would be forced to shut or reduce services significantly. The Department of Health is already discussing handing the management of 10-20 hospitals to the German firm Helios. It is inevitable that people will link the closures to the NHS reforms. The latest proposals remove the cap on private patients being treated by NHS hospitals. Waiting lists are already growing, and will get worse as more capacity is used for private patients. The situation becomes desperate when hospitals in financial difficulty make up the deficit by taking on more private treatment.

Southampton doctors join NHS reforms protest

September 7, 2011

FIVE Southampton doctors have signed a letter calling on the Government to scrap its health reforms. GPs and specialists were among the 400 medics who said the changes would cause “irreparable harm” to the NHS. Their intervention came at a critical time for the controversial legislation as it was last night debated for one of the last times on the floor of the House of Commons. In June the Government announced a series of changes to the original proposals in the face of mounting opposition.

Among the changes are plans to allow hospital doctors and nurses – not just GPs – on new commissioning consortia and scrapping an April 2013 deadline for the new boards to take over. Unveiling the updated bill to MPs last night, Health Secretary Andrew Lansley said new safeguards had been introduced to guard against privatisation, but critics are still worried.

Signatories to the letter included Southampton medics Dr Colin Godber, a retired psychiatrist, consultant haematologist Dr Matthew Jenner, consultant medical microbiologists Dr Sue O’Connell and Dr Adriana Basarab, and Dr Tom Bennett, a paediatrics specialist. Calling on the Government to withdraw the bill, it said: “This legislation will cause irreparable harm.”

Save our NHS Protest in the Market Square on 6th September – report and photos

On Tuesday 6th September 2011 people gathered from 5.30pm in the Market Square, Nottingham to protest at the Health and Social Care Bill.
MPs vote on the Health and Social Care Bill this evening. A public meeting Save our NHS: Kill Lansley’s ‘amended’ Bill will be held in Nottingham on 22nd September. Find more photos on Nottingham Indymedia.

Anti-cuts groups descend on banks in NHS protest

May 28, 2011

Protesters have been holding demonstrations outside high street banks around the UK and have succeeded in occupying a number of branches in the biggest direct action to date against proposed changes to the NHS. The national protest, designed to draw attention to the banks’ role in creating the deficit, is being spearheaded by the anti-austerity campaigning group UK Uncut, which has been were joined by trade unionists and others. Activists dressed in doctors’ coats and armed with fake blood had planned to enter branches and set up mock hospitals and “operating theatres”. Instead they mostly staged their protests on the streets outside when branches were closed or police kept them out. After assembling shortly before midday in London, close to 100 protesters staged actions outside three banks in Camden and held a mock trial of the health secretary, Andrew Lansley. Other groups were able to enter a Natwest bank in Brixton and a branch of RBS in Islington and stage protests inside.

“The NHS did not cause the financial crisis – the banks did and are continuing to make billions in profits. And yet it is the NHS which is being cut,” said Candy Udwin of the Camden Keep Our NHS Public campaign, which took part in north London. “Here in Camden there are hundreds of jobs under threat and that is why protests like this are being strongly supported.” Activists said they had occupied a number of banks in Brighton while actions also took place in Plymouth, Oxford, Leeds Liverpool, Bournemouth, Cambridge, Ipswich, Glasgow, Edinburgh and Dundee. Protesters outside a branch of HSBC in Newcastle were joined by the musician and activist Billy Bragg, who addressed them by megaphone. Other high-profile supporters included the comedian Josie Long who protested at Homerton hospital in Hackney, east London. As well as banks, UK Uncut activists returned to branches of companies they had targetted in the past, including a branch of Vodafone in London and a Topshop in Cardiff. The only reports of arrests were in Manchester, where nine protestors who entered a branch of Santander in Market street were arrested

“The protest was entirely peaceful and yet the police felt that they needed to do this. The public reaction to the police making the arrests was overwhelmingly negative” said David Hoyle, a UK Uncut activist who was outside the bank. Sarah Richardson, a social worker who took part in protests in Newcastle, said: “This coalition government is breaking its election promises to protect the NHS – 50,000 staff are set to lose their jobs and vital services are being cut. Today we’ve shown that there are alternative to the cuts – the government could cut the massive subsidies to the banks that caused the crisis and use this to protect vital services.” In Oxford, Helen McCarthy said: “I took part in today’s protest because I wanted to show that I will not be deterred by the mass arrests that outrageously took place on the TUC march at Fortnum and Mason. It was simply an example of political policing to deter protesters from taking action against these brutal cuts. Instead of making us weaker we are just growing bigger and stronger.”

UK Uncut said that as many as 40 banks across the country were closed, sometimes with activists inside, adding that the reaction from bank staff had been good-natured. The Public and Commercial Services union (PCS) had encouraged members to attend. Dubbed “the emergency operation”, the day of protests is the first big action organised by UK Uncut since the arrests of 145 protesters during a sit-in at Fortnum and Mason in London on 26 March, when more than 250,000 people who took to the streets to protest against government spending cuts. UK Uncut has staged a series of campaigns against tax avoidance and public spending reductions since it was formed in October. A Barclays spokesman said: “We are aware of the protests and our priority is the safety of our customers and colleagues and to ensure that the branches can continue to operate wherever possible.” A NatWest spokesman added: “We are aware of the protests and our priority is to minimise disruption to customers.”

The Government denied the NHS budget was being cut and said it had in fact been protected from the spending cuts “needed to deal with the deficit.” “This government believes passionately in the NHS and is investing an extra £11.5 billion over the next four years, a sign of the commitment to protecting it for the future, so there is no excuse to cut back on services that patients need,” said a Department of Health spokesman. “The plans to modernise the NHS will help to ensure that bureaucracy is cut and resources are reinvested into improving the quality of care for patients. Every penny saved from efficiencies, including savings of £1.7bn a year by 2014-15, will be reinvested into frontline services to improve quality for patients.”

UK Uncut activists in Brighton NHS protest

May 28, 2011

About 30 activists campaigning against proposed changes to the NHS have protested outside banks in Brighton. Sussex Police said the UK Uncut demonstrators met at the clocktower before visiting banks in North Street. They said the “good-natured” activists ended their protest outside Top Shop in Western Road at 1400 BST. Their action was part of a nationwide protest calling for the banks, rather than cuts to public services, to pay for the economic crisis. Banks in London, Manchester, Glasgow, Cambridge and Bristol were among those occupied in the protest dubbed the Emergency Operation.

House of Commons Hansard Debate September 7, 2011

7 Sep 2011 : Column 490

Mr Lansley: If my hon. Friend will forgive me, I will not give way because other Members wish to speak on Third Reading.

In Wales, a Labour Government are cutting the budget for the NHS. The coalition Government’s commitment to the NHS will not waver. The Government and I, as Health Secretary, will always be accountable for promoting and securing the provision of a comprehensive health service that is free and based on need, not ability to pay.

What matters to patients is not only how the NHS works, but, more importantly, the improvements that the modernisations will energise—a stronger patient voice, clinical leadership, shared NHS and local government leadership in improving public health, and innovation and enterprise in clinical services. Everyone will benefit from the fruit that the Bill and the reforms bring. There will be improved survival rates, a personalised service tailored to the choices and needs of patients, better access to the right care at the right time, and meaningful information to support decisions. The Bill provides the constitution and structure that the NHS needs to work for the long term.

Patients know that it is their doctors and nurses—the people in whom they place their trust—who make the best decisions about their individual care. The Bill is about helping those people to become leaders. It is not about turning medical professionals into managers or administrators, but about turning the NHS from a top-down administrative pyramid with managers and administrators at its zenith into a clinically led service that is responsive to patients, with management support on tap, not on top. It is about putting real power into the hands of patients, ensuring that there truly is “no decision about me without me”. My only motivation is to safeguard and strengthen the NHS, and that is why I am convinced that the principles of this modernisation are necessary.

Of course, the Bill has been through a long passage. There have been questions and new ideas, and many concerns and issues have been raised. We have done throughout, and will continue to do, what all Governments should do—listen, reflect, then respond and improve. The scrutiny process to this point has been detailed and forensic. There were the original 6,000 responses to the White Paper consultation, many public and stakeholder meetings and 28 sittings in Committee, after which the hon. Member for Halton (Derek Twigg) acknowledged that “every inch” of the Bill had been scrutinised, but we were still none the less determined to listen, reflect and improve.

I wish to thank the NHS Future Forum, under Steve Field’s leadership, for its excellent and continuing work. I also thank more than 8,000 members of the public, health professionals and representatives of more than 250 stakeholder organisations who supported the Future Forum and the listening exercise and attended some 250 events across the country. That forum and those people represented the views of the professionals who will implement and deliver the changes, and we accepted all their core recommendations. We brought the Bill back to Committee—the first such Bill since 2003—and we have continued to listen and respond positively. The Bill is better and stronger as a result.

Mr Cash: Will my right hon. Friend give way?

7 Sep 2011 : Column 491

Mr Lansley: No.

At the heart of the changes is support for clinical leadership, which has always been key in putting health professionals, and not only managers, at the heart of decision making in the NHS. That was why we strengthened the Bill to ensure that all relevant health professionals would be involved in the design and commissioning of services at every level and in the leadership of clinical commissioning groups. They will also be brought together through clinical networks on specific conditions and services, as they often are now, such as in the case of cancer networks. They will be brought together in broad geographic areas, through new clinical senates, to look across services and advise.

The Bill was strong in transparency and openness from the outset, and that now flows through every aspect of modernisation. Indeed, the Future Forum is taking forward another of our central principles of reform, which is to develop high-quality and integrated services. Properly integrated services are essential for the quality of individual care and for the most efficient operation of the NHS. That was why we proposed health and well-being boards, to bring together all the people who are crucial to improving health across an area and having a real impact on the causes of ill health. We can bear down on the inequalities in health that widened under the previous Government.

The Bill now makes our commitment to integration explicit. Clinical commissioning groups will have a duty to promote integrated health and social care based around the needs of their users, and we will encourage greater integration with social care by ensuring that CCG boundaries do not cross those of local authorities without a clear rationale.

The Bill has deserved the attention and passion that it has attracted, and which I am sure it will continue to attract. I thank all Members who have taken part in the scrutiny of it on Second Reading, in Committee, on recommittal and during the past two days. I especially thank my ministerial colleagues, who have steered the debates and led the preparation of and speaking on the Bill. I thank all colleagues throughout the House who have contributed, especially many of my colleagues who I know have given an enormous amount of time, energy and hard work to supporting the Bill. I also thank the Whips.

I thank the Officers of the House and, especially on this occasion, my departmental officials who have responded tirelessly not only to our requests for information and advice but to those of many hon. Members and thousands of people across the country and in stakeholder organisations.

The intensity of debate and the brightness of the spotlight shone upon the Bill have made it a better Bill than when it was first laid before the House. I believe that it will set the NHS in England on a path of excellence, with empowered patients, clinical leadership and a relentless focus on quality. Let us look at what we have already achieved as a Government: more investment in the NHS, higher quality despite increased demand, waiting times remaining low, MRSA at the lowest level ever, mixed-sex accommodation breaches plummeting, and thousands more people getting access to cancer drugs. The Bill will pave the way for even more progress towards the world-class NHS that patients want, which will be able to deliver results that are truly among the best in the world. I commend it to the House.

7 Sep 2011 : Column 492
6.39 pm

John Healey (Wentworth and Dearne) (Lab): This Government and this Bill are giving health reform a bad name. The Bill is unwanted and unnecessary. It is reckless to force through the biggest reorganisation in NHS history at the same time as finances are tight and pressures on the health service are growing. The big quality and efficiency challenges that the NHS must meet, and the changes that the NHS must make for the future, will be made harder and not easier because of the Bill.

I thank my shadow ministerial team, who have done such a sterling job. I also thank my Back-Bench colleagues who served on not just one, but two Public Bill Committees, and all my Back-Bench colleagues, who have given such strong support to the Opposition in the House.

I should also pay tribute, if I may, to the stamina of the ministerial team, but I say this to them: we will not let up now, because in 13 years of Labour reform and investment, people saw huge improvements in the NHS, the lowest ever waiting times, and the highest ever patient satisfaction; but in this the first year of this Tory-Lib Dem Government, people have instead seen the NHS starting to go backwards. They have seen the Prime Minister breaking the very personal promise that he gave at the election to protect the NHS. As we heard at Prime Minister’s questions today, he and his team are in denial about the damage that his Government are doing to the NHS and the scale of criticism and opposition to it.

The Prime Minister’s pause to listen was supposed to have won back public support and confidence among NHS staff. He failed. It is true that changes have been made to the Bill, but they make the NHS plans more complex, more costly and more confused. Millions of pounds will be wasted on new bureaucracy when it could and should be spent on patient care.

As the House is asked to approve the Bill on Third Reading tonight, the essential elements of the Tory long-term plans to see the NHS broken up as a national public service, and set up as a full-scale market, are still in place. First, on the market, a new regulator will enforce competition law on the NHS for the first time, and it will have the power to fine hospitals 10% of their turnover for working together. The Office of Fair Trading will oversee mergers if a hospital’s turnover tops £70 million. There will be no cap on the number of private patients that are treated in our NHS hospitals as NHS patients wait longer. That means more legal challenges from competition lawyers, more privatisation and the closure of NHS services and hospitals. It means that much of the planning, collaboration and integration that is at the heart of the best of our NHS today will be very much harder, and perhaps illegal, in future.

Secondly, the Bill betrays a founding principle of the NHS. For 65 years, people have known that the Secretary of State and the Government whom they elect are responsible for the definition and provision of a comprehensive health service. The Bill passes that power to at least 250 local commissioning groups and stops the Secretary of State directing them as to the services that they must provide for patients. It makes the Government unaccountable for what health services are provided and unable to guarantee patients a universal service. It is a fundamental and founding principle that

7 Sep 2011 : Column 493

our NHS is a national service, equally there for all, whoever we are, wherever we live. This Bill takes the “national” out of the national health service.

In January on Second Reading, I said of the Government’s NHS plans that the more people learn about them, the less they like them. That was true then and it is true now, despite the many changes to the legislation. These are the wrong reforms at the wrong time, driven by the wrong ideology. Labour will continue to lead the challenge against these plans in the other place, and we will oppose this Bill tonight on Third Reading.

Several hon. Members rose —

Mr Deputy Speaker (Mr Nigel Evans): Order. As Members will see, we have only a very short time before I put the Question, so could they please be very pithy and short in their contributions in order to get as many Members in as possible?
6.45 pm

Dr Sarah Wollaston (Totnes) (Con): The hon. Member for Bethnal Green and Bow (Rushanara Ali) spoke of health inequalities in her constituency. Perhaps she should look at the King’s Fund’s annual review of NHS performance between 1997 and 2010, which

“identified the lack of progress in reducing health inequalities as the most significant health policy failure of the last decade.”

Opposition Members should bear that in mind when they talk of a two-tier health service, because they fail to focus on outcomes and they fail to focus on inequalities.

I welcome the duty of the Secretary of State, the NHS commissioning board and clinical commissioning groups to have regard to reducing health inequalities. Let us see something done about that scandal. I also welcome the work of the NHS Future Forum in setting out the central dilemma surrounding the role of the Secretary of State. The NHS should be freed from day-to-day political interference, but it must also be clear that the Secretary of State retains ultimate responsibility.

Debbie Abrahams (Oldham East and Saddleworth) (Lab): Will the hon. Lady give way?

Dr Wollaston: I will not, because so many Members are waiting to speak.

There has been real scaremongering about, in particular, the difference between the duty to provide and the duty to secure provision, but I believe that the wording simply reflects the reality. The key issue is the line between the ability to step in if things go wrong, and the very real need for politicians to step back and let clinicians and patients take control.

I shall cut my speech short because I have been asked to be brief, but let me end by saying that, for three clear reasons, I would not be supporting the Bill if I thought that it would lead to the privatisation of the NHS. [Hon. Members: “Have you read it?”] I assure Members that I have read it in great detail.

Let me give those three clear reasons. First, clinicians will be in charge of commissioning. Secondly, the public will be able to see what clinicians are doing. Thirdly,

7 Sep 2011 : Column 494

neither clinicians nor the public will allow privatisation to happen. They do not want it to happen, and neither do Members of this House.

PCTs and foundation trusts did not meet in public, but they will do so in future, and it is the public and patients who will ensure that the NHS is safe in the hands of the Conservatives and the Liberal Democrats.

Mr Deputy Speaker (Mr Nigel Evans): That is the length of speech that we like.
6.47 pm

Rosie Cooper: I fear that for all the listening, the work of the Future Forum, the concerns voiced by health professionals and our constituents who rely on the health service, and the two days of debate in this place, we have ended up on Third Reading with something that is not substantively different from the original idea. Although it is three times longer than the National Health Service 1946 Act, which created the NHS, the Bill before us leaves us with more questions than answers. I suspect that that will remain the case for some time, as the Government have indicated that more amendments will be tabled.

It is astonishing that we have progressed from a Bill that was never meant to be, because the Conservative party had promised no top-down changes to the NHS, to the Conservatives’ having a supposedly well-thought-out plan—which required a pause because of the sheer scale of the public’s and medical professions’ opposition—and then to the Bill that we have today, which needs more amendments. Sadly, the changes are not substantive enough. The Minister told us yesterday that 715 of the 1,000 amendments were intended merely to change the words “commissioning consortia” to “clinical commissioning groups”. I believe that the public, clinicians and those of us who could see right through the Bill were looking for something more substantive when the Government stopped to pause and promised to listen to people’s concerns.

The Health and Social Care Bill that we now have is still as confused and muddled as on the day it was first brought before the House. I expect that Ministers hoped to confuse and bore people into submission. Disgracefully, the Government began to change the NHS structures without the consent of the people even before they produced the Bill, and they continue to do so even though it has not passed through this House or proceeded to the other place—where it is to be hoped that it will receive the thorough and tough consideration that we should have had the time to give it here.

What we have is a Bill that is high on autonomy and low on accountability. It is supposed to be built on the principles of efficiency, reducing bureaucracy and cutting out waste, yet I do not believe it achieves any of them. In fact, in practice it does the opposite. The Bill will leave us with an organisational malaise, as the number of bodies and organisations significantly increases, with the relationship between them all being complex and incoherent and severely lacking in detail and accountability. The Bill leaves us with a financial challenge that has never been achieved in any health economy anywhere in the world at the same time as removing great swathes of the people with the experience and skills to deliver this outcome. The Secretary of State said that he admired NHS employees. If that is so, why have his policies led to so many of them losing their jobs?

7 Sep 2011 : Column 495

The Bill will leave the NHS open to European competition regulation, all of which will be overseen by an economic regulator enforcing competition who appears to think the system can be based on an outdated and failing regulatory model like that of the utilities sector, and whose accountability to Parliament and the Secretary of State is unclear. Ultimately, I believe the Bill has been driven forward as an ideological exercise, rather than through a desire to improve the quality of health care available to the people of this country. The Government could have achieved the changes they said they wanted without all this structural mayhem, such as by reducing the number of primary care trusts, changing the make-up of the boards and putting clinicians firmly in the driving seat, but perhaps that was not macho enough.

This evening, the Government are in serious danger of consigning to the bin 13 years of progress, in which patients were being treated within four hours in accident and emergency and were guaranteed an operation with 18 weeks. Tonight, I genuinely fear that the Bill before us will be the equivalent not of throwing a grenade into the NHS, but of pushing the button on the nuclear option: a completely disproportionate response to the challenges facing the NHS.

In my speech on Report, I referred to the former NHS employee Roy Lilley and his blog. Today, he takes a quote from Mary Anne Evans, otherwise known as the novelist George Eliot:

“It is never too late to be who you might have been.”

I therefore urge the Liberal Democrat Members of this House to consider whether they genuinely believe this Bill will deliver a better, more caring and more patient-led NHS.

Earlier in the debate there were suggestions of scaremongering, so let me be clear: I am not scared; I am terrified—terrified that this Conservative Government will kill off the NHS, a system of health care that is envied throughout the world and that is being threatened for the sake of ideology. I am not scaremongering when I say that if this Government destroy the NHS, they will never be forgiven.

6.53 pm

Nicky Morgan (Loughborough) (Con): In yesterday’s debate the right hon. Member for Holborn and St Pancras (Frank Dobson) said of the NHS that he believed that in most parts of the country and most of the time it does a good job for people, but I want to see it doing an excellent job for people in all parts of the country all the time, and that is what this Bill will achieve. Having served on the Bill Committee, it is a great sadness to me that that message, and the fact that patients will be at the heart of the NHS, has been lost in the months of scaremongering—a word used by the last speaker—and wrangling by those who have campaigned against it and have obscured all such messages. That has been totally unfair to the patients who rely on the NHS.

I briefly want to make two points. First, Members who served on the Committee will know of my passion for getting the right treatment for mental health patients, and at a meeting of the all-party group on mental health yesterday the Bill was described by GPs as a great opportunity: an opportunity for the integration of primary and secondary care—something they have not had before, and that will now be achieved.

7 Sep 2011 : Column 496

Secondly, as my hon. Friend the Member for Totnes (Dr Wollaston) said, the Bill puts clinicians at the heart of commissioning. When the Bill was recommitted, my researcher said to me, “This Bill is a gift that keeps on giving.” Now it is time for this present to be handed over to the other place, but it needs to reach the statute book and we need to implement it on the ground. I have heard nothing from the Opposition in the past eight months to convince me that this Bill should not receive its Third Reading and get on to the statute book, and I urge all hon. Members to support it.

Mr Deputy Speaker (Mr Nigel Evans): I am grateful for that short speech. I ask for another short speech from Kevin Barron.
6.55 pm

Mr Barron: I have been a Member of this House for 28 years and I have been active in different parts of health policy for many years, and I have never seen any Bill—not just any health Bill—come to this House so ill-prepared to be put on to the statute book. I served during the two stages of the Public Bill Committee. Largely, I asked questions where I wanted explanations, but I got very few answers. As was said earlier today, part 3 remains in this Bill and its 97 clauses bring in economic regulation. Only nine of those clauses have been amended since the Future Forum met and said that we were in deep trouble with this.

What did the Future Forum ask for? It recommended that Monitor’s powers should

“promote choice, collaboration and integration.”

Monitor’s powers have changed somewhat, but the major change that occurred during the second part of the Committee stage was that the Government took away Monitor’s power to promote competition and gave it a new power to prevent anti-competitive behaviour. Perhaps, at some stage, somebody will be able to tell me what that means. Perhaps somebody will also be able to tell me the answer to something I asked in the first sitting of the Public Bill Committee: what do the Competition Commission and the Office of Fair Trading have to do with the mergers of two NHS trusts? The relevant Minister said at the time that that was a good question, but I have not heard it answered since.

I must say, with all due respect, that no Labour Member argued that the NHS is perfect, nor would I do so. But this Bill is a dog’s dinner. The national health service and the nation do not deserve it, and I will vote against it tonight.
6.57 pm

Mr Stephen Dorrell (Charnwood) (Con): Like my hon. Friend the Member for Totnes (Dr Wollaston), I would vote against the Bill if I thought that it was going to promote the privatisation of the NHS. One thing that this Bill has in common with every health Bill I have attended in 21 years is that its opponents claim that it is about privatisation, but it is about nothing of the kind.

As the Secretary of State made clear, this is a different Bill, in some important respects, from the Bill that was first presented. First, the Bill introduces a statutory duty to promote the integration of health and social care—Labour Ministers talked about that but never

7 Sep 2011 : Column 497

delivered it. Secondly, the Bill introduces new safeguards against cherry-picking by private sector providers—Labour Members say they were against cherry-picking but they never introduced such safeguards. Thirdly, the Bill introduces new safeguards in respect of the continuity of essential services provided by private providers, who were introduced by Labour into the delivery of health and social care—such safeguards were never provided by Labour. Fourthly, the Bill makes real a commitment to the introduction of the clinical leadership of commissioning—Labour talked about that in office but never in reality delivered it. So this is a Bill that has been changed and improved as it has gone through the parliamentary process.

Let us not belittle the extent to which the Bill actually builds upon the same policies that were pursued by Labour in government: a policy of the extension of commissioning to act on behalf of the patient and the taxpayer; a policy to promote the development of foundation trusts as the best way of delivering care. This Bill takes 20 years of consistent development of policy and converts the words of Labour Ministers into reality. That is why I support its Third Reading tonight.
6.59 pm

Mr Michael Meacher (Oldham West and Royton) (Lab): Extremely briefly, I want to put on record my view that the Government’s handling of this Bill has been a monumental abuse of the principles of accountability in this House. It was sprung on an unsuspecting nation after an election in which there was no mention whatsoever of these proposals, after an air-brushed Cameron advert said, “I will cut the deficit, not the NHS.” Despite those misleading signals, there has been no commission of inquiry to examine its philosophy or ideology, no proposal to pilot it—
7 pm

Debate interrupted (Programme Order, 6 September).

The Deputy Speaker put forthwith the Question already proposed from the Chair (Standing Order No. 83E), That the Bill be now read the Third time.

The House divided:

Ayes 316, Noes 251.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110907/debtext/110907-0005.htm