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

It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), who has taken us round a number of issues, particularly in relation to the public's ability to scrutinise, through the proposed healthwatch organisations, the effective delivery of commissioning in their areas. As my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) suggested, there is a desperate need for provision within our procedures whereby important pieces of legislation such as this, which have been significantly altered in another place, can be reviewed on Third Reading. Our earlier debate about the still unpublished transitional risk register was, in a sense, a proxy for that lack of a Third Reading debate. This debate has placed public health and the role of HealthWatch, particularly local healthwatch, in the context of local health services being placed at risk. We have already discussed how clinical commissioning groups may be fundamentally conflicted. In my contribution to that debate, I posed questions about the conflicts that intrinsically exist within those organisations. I believe that HealthWatch should be there to provide scrutiny of those conflicts. Throughout the debates on the Bill, fundamental concerns have been expressed about the fragmentation of local health services. We need a strong and independent-minded local healthwatch in all our areas to be watching for that and looking out for opportunities to maintain the integration of local services. I fear that one of the effects of such a major reorganisation of the health service nationally and locally will be to make it more difficult to deliver the £20 billion efficiency gain that the previous Government proposed and that the coalition Government intend should be delivered. That issue needs to be considered at national level, with HealthWatch, and at local level. I believe that we need an independent body that is capable of ensuring that efficiency gains are being achieved at local level and that keeps an eye on the commissioning and delivery of local health services. The Royal College of Nursing has said today that there is a need to look carefully at staffing levels in front-line health services, including in acute hospitals. There is a debate about whether that should be mandatory. That has long been a concern of mine when looking at the delivery of local health services and it is identified by people when they visit hospitals. There are staff-to-patient ratios that, in my view, are barely tenable and barely safe. Qualified nurses are struggling to provide the kind of support and care that patients require, simply because the staffing ratios are inadequate. The same ratios may have been adequate in the past when the throughput of patients and the acute status of patients were lower, but with the current turnaround of patients and their acute status, it is no surprise that the RCN's survey has identified the need to review staffing levels in our wards.