Health Bill [Lords]

Thank you, Madam Deputy Speaker. Notwithstanding the recent debates on tobacco, at the heart of the Bill was the intention that incorporating the NHS constitution and measures relating to quality and innovation in the Bill should drive forward an improvement in the quality of health care for the people of this country. We made it clear to Ministers from the outset—my right hon. Friend the Leader of the Opposition and I had made it clear for a considerable time—that we wanted an NHS constitution, and believed in the importance of incorporating the principles of that constitution and making clearer to the public the nature of their rights and entitlements and, indeed, the obligations they should have. I am pleased that the Bill has enabled the NHS constitution to be referred to in legislation, but unfortunately, in these latter stages, Ministers have chosen not to incorporate its core principles directly in the legislation. I must confess that I find it astonishing that the Minister of State should have thought that expressing the core principles in legislation would, of itself, lead to litigation about those core principles, given that in any case the purpose of the NHS constitution is that every NHS body—or those contracted to provide services for the NHS—should have regard to those principles. If the Minister is suggesting that by leaving them out of the Bill, he leaves them out of the legal duties placed on NHS bodies and those NHS contractors, I am afraid that that simply serves to undermine his own argument. As we know, the core principles of the NHS were stated by Ministers in the NHS plan in 2000. As Minister of State, the Secretary of State launched a consultation on the subject, and arbitrarily changed what he regarded as core principles. Perhaps he intends to change them once again. As I recall, when he introduced them he left out the principle that resources provided for the NHS should be used solely for the benefit of NHS patients. I am afraid that the Bill does not drive forward reform and does not drive forward quality. We did not discuss this evening, but at an earlier stage, the obligation to produce quality accounts. I have to hand the quality report produced by the Wrightington, Wigan and Leigh NHS Foundation Trust, which is the Secretary of State’s local hospital. As a result of it, he will know perfectly well that nothing prevents a requirement from being placed on hospital trusts, or prevents him from providing for such an obligation on primary care trusts, without it having to be written into legislation. We also learn that the publication of quality accounts will essentially be a self-justificatory exercise on the part of NHS bodies; they will choose what constitutes quality when they present them. However, I do not want to be anything other than generous in approach at this late stage in the consideration of the Bill. It contains necessary and helpful measures, such as the incorporation of the NHS constitution, but we know that we will have to go further in future. The incorporation of direct payments into legislation is a good thing as well. I am delighted that, whereas the Government resisted our view that direct payments should be able to be extended to incorporate health and social care three and a half years ago, we have now arrived at the point of their having come round to that way of thinking. I am also pleased that the Government have legislated for the investigation of complaints about privately arranged or funded adult social care. I just hope that when Ministers come to reply to this short debate, they will say that they will be able to make progress in the next few months on incorporating that. A lot of people whose social care is arranged privately will continue to be without that protection unless there is fast progress. It was also important for the House to have an opportunity to look at the issues relating to tobacco, although I may not agree with all the conclusions that it reached. The amendment of the right hon. Member for Makerfield (Mr. McCartney) has been passed, doubtless with discussions between him and the Government Front-Bench team, but there is a question that I need to ask if he does not: what is their intention in relation to these regulations? Our view is that to make regulations that would ban all vending machines would be disproportionate, but the Government seem to have acquiesced and voted for this power, so is it their intention to use such a power, or not? We shall see; perhaps Ministers will tell us. Finally, I am disappointed at this late stage in what the Government have demonstrated in their reaction in the past two months to the Mid Staffs situation. We debated that earlier so I will not return to all the issues, but I am afraid that their inclusion of the de-authorisation provisions is a further indication that they have given up on the reform process they were pursuing a few years ago. According to former Prime Minister Tony Blair, foundation trusts were integral to that reform process, yet Ministers have not only stalled on the process of creating foundation trusts but are now actively seeking to de-authorise them and are looking for opportunities to do so. We know that they have abandoned "any willing provider" as a basis for introducing competition into the provision of NHS services, and we know that measures to do with patient choice and practice-based commissioning have also been stalled, so some measures that would best deliver improved quality in the NHS through reform processes in the service have been undermined by decisions that are now being taken by the Government. Therefore, this Bill is not a flagship for reform; rather, it is a portmanteau Bill. It contains measures that we welcome, and others that will be good or bad depending on how they are used, such as pharmaceutical needs assessments; but it will not, in itself, achieve a substantial shift forward in quality, innovation and performance across the NHS, because it is no more than a collection of modest changes. To that extent, although there are measures that the Government have included in the Bill—not least today—to which we object, we will not resist it at this stage. However, I encourage those who have yet to consider it in another place to look very hard and critically, not least at the de-authorisation of NHS foundation trusts. May I conclude by thanking my colleagues my hon. Friends the Members for Eddisbury (Mr. O'Brien) and for Hemel Hempstead (Mike Penning), who have done all the heavy lifting in relation to this debate? As today’s debate has served to illustrate, they have done so magnificently.