Health and Social Care Bill (Programme) (No. 4)

It is important to begin by setting out the background to many of the amendments in this group. Despite the pause that the Government ordered for the Bill, they failed to allay fears about the creation of a market based on a 1980s utility privatisation, with Monitor acting as an economic regulator—a parallel drawn last November not by me, but by the King's Fund in a report it published. That, more than anything else, has been behind the huge professional disquiet about the Bill that we have seen over recent weeks and months, with respected professional organisations coming out one after another to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, doctor against doctor. That is where we start. The Minister began his remarks by talking about the myths relating to part 3 of the Bill and objecting to some of the interpretation that I have just given. I do not know who he had in mind when talking about those myths, but it might have been the noble Baroness Williams. I will quote from an article she wrote in The Guardian on Monday 13 February. It is important because it explains the genesis of one of the amendments that the House is considering tonight. She acknowledged that there were:"““fears among the public and within the medical profession that clinical commissioning groups might become dependent on advice from powerful private health companies, and that the imposition of UK and European competition laws, addressed to markets and not to social goals, might destroy the public service principles of the NHS. In plain terms, this is often described as a fear of privatisation. These are issues that must be addressed.””" When the Minister talked disparagingly about myths, did he have the noble Baroness in mind? I think that he must have done, because in the same article she went on to suggest that the answer to the concerns and fears that she had correctly identified was to drop the whole of part 3. She wrote:"““What that would mean for the bill would be dropping the chapter on competition, and retaining Monitor as the regulator of prices and of the foundation trusts.””" I am not privy to the internal machinations of the Liberal Democrats, but I think that there must have been some wrangling and soul searching in the two weeks following the publication of that article, because by 27 February a letter had emerged that was co-signed by the noble Baroness and no less a figure than her party leader, the Deputy Prime Minister. The call to drop part 3 of the Bill, which had been made so eloquently in The Guardian two weeks earlier, had in fact turned into something very different. The letter stated that they needed to go further to amend the Bill in order"““to rule out beyond doubt any threat of a US-style market””." If what the Minister has said at the Dispatch Box this evening is true and all these fears are myths, why did his party leader and the noble Baroness send that letter? Indeed, why were there even concerns about the threat of a US-style market, which his party leader acknowledged on 27 February? They do not sound like myths to me; it sounds like they were very real threats indeed. What I want to address this evening is the fact that when the package of amendments that were meant to put the Clegg-Williams package into the Bill finally emerged, they fell considerably short of what was promised in the letter. Indeed, we are dealing with some of those tonight. I will focus on Lords amendment 148 in particular, which deals with the private patient income cap. When the Minister spoke a moment ago, I did not find him reassuring at all. When he spoke about foundation trusts in the future he said that they would of course remain the principal providers of NHS services, but I do not find that at all reassuring. The exchange he had with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) was very revealing. The right hon. Gentleman made a mistake that the noble Baroness made when she took on Polly Toynbee on the same issue. The right hon. Gentleman, like the noble Baroness, does not seem to understand the effect of the amendments he is agreeing to. He began by asking, ““Wasn't it the case that the 49% figure was now completely ruled out and wasn't relevant?”” No is the answer to that. All that the Minister has offered him is that if the increase is more than 5%, it then has to be passed by a vote. I find it incredible that a Member of his years and standing in this House has just revealed that he does not understand the amendments that have been signed up to in order to deliver the package set out in the Clegg-Williams letter. That is a terrifying state of affairs; I do not know what the Members in his party who voted against that might make of it.