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

These amendments—the last group that we shall consider tonight—contain important issues, including that of local community involvement, which was raised by the hon. Member for Leicester West (Liz Kendall). Like other Members, I have an interest in the subject, and have done so throughout my time in politics. I happen to know Malcolm Alexander—who was cited by the hon. Lady—very well, because he was once secretary of Southwark community health council. Let me present my honest opinion of the Bill to my friends on the Government Front Bench. It is not the Bill that I would have presented to Parliament. I think that it has gone much too far in its efforts to introduce top-down reorganisation, which is not what we told the public we would give them; and although there was a fine balance between the arguments in favour of primary care trusts and those in favour of the new structure that we have created, I believe that by changing what we said we would do we have caused more uncertainty, not least among health professionals. Nevertheless, I am convinced that the process to which the Bill has been subjected has improved it hugely. I am convinced that a year ago my party colleagues performed a public service by setting out an agenda for change, and that we have helped to persuade the Government to amend the Bill in 2,000 different ways. That is not my figure, but one given by the Library in a note with which it provided us before the debate. Since the Bill returned to Committee about a year ago, 2,000 amendments have been tabled, many of them in the House of Commons after the Future Forum had done its work. Today we are considering—technically—374 amendments, all of which are going in the right direction. It is interesting to observe that only three Labour amendments have been tabled today to the changes proposed by the House of Lords, and that two of them dealt with the same issue. Effectively, that means that the Labour Front Bench has sought to change only three of the many proposals made by the Lords. Of course the 374 amendments are not all substantive—some are consequential, and some are small—but we should not undermine or understate the substantive changes that have been made since the Bill left this place. Many outside the House believe that there is an opportunity for Members of Parliament to vote on every Bill at the end of all its proceedings, and to deliver a final yes or no decision. There is not, although I think that there should be. I hope to persuade colleagues that we can change our procedure so that all public legislation, whether it starts in the Lords or the Commons, ends up in the Commons for Third Reading. I think that that would make for more democratically accountable decisions. We could then examine the Bill as amended by the Lords, and take a final view. However, we are not there yet; tonight we are considering all these amendments, and with them I thoroughly concur. I have listened to the debate about accountability, and I accept that there is real disagreement on whether the new system proposed by the Government, at short notice, is an adequate substitute for the statutory HealthWatch. I remember a time—the hon. Member for Leicester West was not in the House then—when, from the Opposition Benches, I ferociously opposed the Labour Government's proposal to abolish community health councils. I thought that it was a move in the wrong direction, as did my constituents. I still believe that any measure that does not empower my constituents— and the hon. Lady's in Leicester—and enable them to become involved in decisions, consultations and processes will not be a good thing. Ministers have been asked some perfectly proper questions today, and I am not 100% persuaded that their answers suggest that we will have the best possible system. Let me be absolutely honest: I believe that although, by and large, the amendments contain huge improvements, there is a great deal of unfinished business. Some will be dealt with in regulations, which will enable us to return to these matters, while some will be judged on the basis of experience. I asked my hon. Friend the Minister of State to put on record the way in which the public can be more involved, because I am clear that there are significant additional opportunities for the public to become involved. That is why, in those areas, it is a good Bill. I am clear that local councils should have more involvement. He may remember that, as my party's representative when the Bill setting up the Greater London authority was introduced, I argued that the GLA should have the power of the London strategic health authority, so that there would be a democratically accountable strategic health authority. I have always believed in more accountable local health services and in local councillors and councils having more say.