Health Bill [Lords]

If we needed any more evidence that this Government are a tad short of support, we only have to recall the notable absence of Labour Members from the debate on this so-called flagship Bill. There was a notable absence of almost every Labour Member between 6 pm and 7 pm, for some reason or another—[Interruption.] It is interesting that they do not want to be reminded of that. The Bill's 36 pages contain 10 policy areas that are completely inconsistent with each other. There is little vision for our NHS and much tinkering with legislation that the Government should have got right first time round. As with so many of this Government's Bills, much of the substance lies in secondary legislation, for which drafts are not yet available, even though the Bill has already been through the other place and there has been plenty of time for the Department to prepare them. The Government probably would not provide time to debate them anyway. This is a wash-up Bill from a washed up Government. Nevertheless, owing to the wide-ranging nature of the Bill we have had an interesting debate with contributions, in the end, from those on both sides of the House. I take this opportunity to welcome the right hon. Member for Leigh (Andy Burnham) back to our health debates, now as the Secretary of State. We will see whether his loss to the blue shirts at Goodison Park will be a gain to the blue scrubs of our hardworking NHS staff. Also, I congratulate the Minister of State, the hon. Member for Corby (Phil Hope), on retaining his post and I welcome the Minister of State, the hon. Member for Lincoln (Gillian Merron). I welcome too the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O'Brien). As well as surnames, we have shared debates before, and I look forward to his generous acceptance of many of our amendments in Committee. The NHS constitution was published in January this year. It is typical of the Prime Minister, who wants to return power to Parliament, that he held a closed signing ceremony in Downing street for this booklet, the contents of which have never been debated in Parliament—and still had not been at the time of the launch. It is right that our NHS should have a constitution. Like a number of proposals in this Bill, it is resonant of Conservative pledges of some years ago. But for such a constitution to be more than just print on paper, it must be put on a statutory footing. It is questionable whether this would make it a lawyers' charter: as the Government have said, many of the principles of the constitution are already underpinned by legislation. We have called for the 10 core principles of the Government's NHS plan to be put in the legislation. It is worrying that a Labour Government, even such a tired one, have cut that number down to seven. The Government's own Back Benchers, along with everyone on this side of the House, should worry that the Government have discarded principle 7, which is:""Public funds for healthcare will be devoted solely to NHS patients"." Indeed, it was the new Secretary of State, when he was a Minister, who made the decision. Where too is the principle that states the need to value NHS staff? In Committee, we will look to enshrine those and other principles in the legislation. I note that we heard a speech from the hon. Member for Dartford (Dr. Stoate) who calls himself a practising GP and was concerned about the absence of GP-led commissioning as a principle. The doctor from Dartford made the biggest case yet to all his colleagues who wish to stop Members having a second job. As for quality accounts, there is no doubt that, as we move the NHS towards greater patient choice, patients should have good data with which to make their choices. As yet, the Government have given insufficient assurance that quality accounts will be substantive pieces of work rather than silver-tongued advertising. The example that the Government have published—that of Sunnyview hospital—hardly inspires confidence. We heard, too, from the other doctor in the House, the hon. Member for Wyre Forest (Dr. Taylor), who made an impassioned speech about what quality of care really means and what a vocation to nurse really means. He had hoped that the constitution could help to ensure that that becomes much more of a reality. We also heard a very important contribution from my hon. Friend the Member for Basingstoke (Mrs. Miller), who made a number of points that ranged right across the Bill. In addition to her comments on the effect of the cap on some of the services at her local hospital, she made a most interesting point, which I had not yet understood, about the concern that children's trusts will not be required to have regard to the NHS constitution. That is of particular concern if children's trusts effectively end up as commissioners for children's services, with a legal footing equivalent to that of primary care trusts. My hon. Friend made an important contribution that will no doubt feature in our discussions in Committee. On direct payments, it will be good to see those on the Government Benches going through the Division Lobby this evening in favour of this opportunity for greater patient choice. We are, of course, a little surprised to see that provision encapsulated in legislation, despite the fact that we have been calling for direct payments since 2004. The Government rejected them in 2006, in a debate on the White Paper "Our health, our care, our say". The then Health Secretary—there have been a number of Health Secretaries—the right hon. Member for Leicester, West (Ms Hewitt), called them a""revival of the patient's passport".—[Official Report, 30 January 2006; Vol. 442, c. 29.]" For the sake of the 15 million patients with long-term conditions and for the sake of our NHS, I am glad that the Government have changed their mind. The hon. Member for Romsey (Sandra Gidley) made some important points about direct payments. She asked about direct payments for maternity care, and that is an issue we shall need to explore in Committee. It struck me as a little odd, as mothers are supposed to have choice already. As Liberal Democrat spokesperson, she showed important support for pilots. However, what matters is that the Government should for once move away from their addiction to pilots and use them to produce an assessment and a proper review before rolling them out, so that the benefits can be enjoyed by all rather than simply by some selected places. Most interestingly, we heard a powerful speech from my right hon. Friend the Member for North-West Hampshire (Sir George Young), who has long experience in this area. He made the very important point that we needed clarity about where direct payments will have an impact in relation to the top-ups that have caused some inconsistency in approach. Again, I hope the Government will take that on directly in Committee and that they will ensure it is explored. We heard a powerful and impassioned speech by the right hon. Member for Makerfield (Mr. McCartney). He talked, among other things, about preventive health care—I think I heard him say that he did not believe that was a partisan point. He and I are London neighbours—just as he is a neighbour of the Secretary of State up in the north-west—and, as he said, he and I have in the past shared some of the great benefits of the NHS as well as some of the challenges that face its future. Let me move on to innovation prizes. Like so much of the Bill, they arise from Lord Darzi's next stage review of the NHS. An unspun reading of that document is "Things the Government have failed to do since 1997". Supporting innovation in the NHS is one of those things. Lately, we have had the Health Innovation Council, created in October 2007, which has met only twice—the last time was in April 2008. The Government created the nine NHS innovation hubs in 2004, whose irrelevance might be linked with their coterminosity with regional development agencies. The NHS Institute for Innovation and Improvement and the National Innovation Centre were established in 2005. It is common ground that well-motivated staff need no prizes for innovation. Those of us who have had experience outside this place—in my case, in manufacturing industry—know that company employees see it as part of their job. In the NHS, we have one of the most engaged, professional and hard-working work forces in the world. However, under this Government their morale has been perennially crushed and it is that demotivation, more than anything else, that stifles the sense of energy and optimism that is needed to fuel innovation, enthusiasm and an acceptance of new ideas and change. I was pleased to note that the Chairman of the Health Committee, the right hon. Member for Rother Valley (Mr. Barron), had some important points to make about trying to disentangle the idea of imposing a process from getting at what changes behaviour and motivates people not just to innovate but to have their innovations championed, accepted and implemented. Although they may not look like it, the Government's plans for trust special administrators are among the most worrying aspects of the Bill because they would change the nature of foundation trusts. Instead of final responsibility lying with foundation trust governors, and ultimately the independent regulator—Monitor—it will lie with the Secretary of State. That may sound like a good thing superficially, but what good is it for governance in any business and how is incentivisation to be accountable if people know that their bad decisions on risk will ultimately be bailed out by the Government? There are also concerns about the power of the Secretary of State over trust special administrators, given that he can direct the meetings they hold. As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) emphasised in a powerful opening speech, a transparent failure regime is required, so we shall need to look long and hard at those proposals in Committee. The move to pharmaceutical needs assessments is welcome. It is clear that such questions should be determined locally rather than nationally. We shall, however, seek assurance from the Government in Committee that their proposals will not impede access to services from patients who currently benefit from dispensing GPs. Patient choice must be the priority in pharmaceutical needs assessments. One of the arguments the Minister will no doubt use in favour of trust special administrators relates to the recent tragedies at Mid Staffordshire NHS Foundation Trust, but that is to shut the door after the horse has bolted. The real question that the new Secretary of State must answer is how the hospitals were ever given foundation trust status in the first place—ultimately solely the decision of the Secretary of State. Events at Mid Staffs and at Maidstone and Tunbridge Wells also inform the suspension clauses in the Bill. The Minister will have to answer questions about why those proposals were originally left out of the Government's legislation. We shall seek assurances that the powers will not be abused—for example, by suspending people who ought to be fired. The speech of my hon. Friend the Member for Ilford, North (Mr. Scott), which drew a parallel with the provisions relating to doctors, was extremely well made. Members on both sides of the House will have their own opinion about the tobacco clauses. Some will see them as too draconian and others will consider them too liberal. Each speaker in the debate touched on that part of the Bill. The right hon. Member for Makerfield made a particularly impassioned speech in that regard, but all Members made important contributions and the debate is to be joined. It is clear that any action taken to reduce smoking must be based on solid evidence, and the Committee will provide a good opportunity to discuss the evidence base for the Government's proposals. I hope the Government will consider how to enable evidence to be put to the Committee. Will they pursue the ideas for determining such matters handed down to us by the other place, such as restricting access to public area vending machines, or a bar or ban on their use, to prevent children from getting hold of cigarettes? We heard contributions on that point from the hon. Member for North-West Leicestershire (David Taylor), the Chairman of the Health Committee and my hon. Friends. If the evidence is weak, the emphasis must be more on the thoughts and feelings of Members, so we have given our side a free vote on that particular matter. I hope the Minister will confirm that his colleagues will be allowed a free vote, too. Dispensing doctors have expressed concern about the move to pharmaceutical needs assessments. We must consider those concerns in Committee. We have talked about the important aspect of adult social care in relation to clause 33. I hope we shall be able to cover it in Committee, too, but it is now 8 June and the Government promised the Green Paper on the subject in the spring. We thought that as carers week starts today, the Green Paper might be published today, but it is still not available. I hope the Minister responsible will be able to give us an indication about that. A welcome amendment was made in the other place to enable the Secretary of State to support better NHS-funded care for patients in foundation trusts. However, Lord Warner told the other place that he repented of the sin of including the provision, which was, he said, only""sops to parts of the Labour Party".—[Official Report, House of Lords, 6 May 2009; Vol. 710, c. 656.]" He pointed out that the cap is arbitrarily applied across the NHS. Important speeches showed that a change from what has been handed to this place for consideration would deny people certain services. In a parallel contribution, my hon. Friend the Member for Ludlow (Mr. Dunne) made a powerful point about where the funding was for the resurrection of community hospitals and refurbishment in his and other areas. I hope that that issue will be considered. Clause 35 relates to the difficulties with disclosure of information. The Secretary of State is aware that, since 2005, the Government's actions in that area have been illegal. It was interesting to hear him say—but not in these words—that he would put matters on a better legal footing. That is one way of not having to admit what had gone before. In supporting Second Reading, I hope we will make sure that we have the parliamentary time needed to scrutinise the Bill. I hope we will have the chance to debate some of its provisions not just in Committee but, if the Government have the necessary courage, on the stump in a general election.