[2nd Allocated Day]

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? 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.