Health and Social Care Bill

It is a pleasure to follow the right hon. Member for Croydon North (Malcolm Wicks) and his encyclopaedic questions. I am sure that, from his many years as a Minister, he knows the kind of comprehensive answers that he would like to receive from Ministers. Indeed, I should be interested in some of those answers, so I congratulate him on asking those questions. Perhaps I should inject a short note of levity into what has been a serious debate so far. I do not have the timing or skills of the late, great Tommy Cooper, but he once told a joke that goes roughly along these lines. A patient runs into a doctor's surgery and says, ““Doctor, doctor, I think I've broken my arm. Can you mend it?”” The doctor looks at the arm and says, ““Yes, I think I can mend it.”” Then, the patient says, ““Doctor, doctor, will I be able to play the piano?”” And the doctor looks carefully at the arm again and says, ““Yes, I'm sure that you will be able to play the piano.”” To which the patient says, ““That's great. I've always wanted to play the piano.”” Doctors often use that joke to emphasise the unrealistic expectations that people have of them, and I have come to the conclusion that there are some unrealistic expectations in the Bill. It is well intentioned and not, as the hon. Member for Eltham (Clive Efford) and others have argued, generated out of malice, dogma or—clearly—ineptitude, but Ministers have perhaps allowed their enthusiasm to get the better of them. There can be no disagreement with the principles that underpin the Bill, in particular greater clinical and patient involvement and driving the quality of innovation, albeit through a number of, admittedly, rather debatable measures. Those are pretty unarguable ““motherhood and apple pie”” principles that ought to underpin such legislation, but many people are concerned about its timing, when all parties agree that the NHS faces one of its biggest ever challenges: the biggest savings it has been asked to make in its 62-year history. At the same time, however, I see the measures as the biggest shake-up of the NHS in its 62-year history. The Bill is well intentioned, but for it to proceed and not damage the NHS it needs further major surgery in Committee before it returns to the Chamber for Report and Third Reading. We need to look at reforming the reforms themselves as part of a constructive approach to engagement. It is not that PCTs are the be-all and end-all of future health service delivery; far from it. No one will die in a ditch to defend them, but, given the institutional architecture that they have provided, after many years of coalescing around and amalgamating the primary care groups that were their heritage, we should establish the default position of assuming that we stick to that coterminosity and structure and then graft on wider clinical involvement. Many GPs in my constituency clearly tell me that they are going ahead with the measures before us more out of resignation than enthusiasm for solely GP-led clinical involvement in commissioning. A lot of them are telling me clearly that they want wider clinical engagement. If there are already 141 pathfinders covering just half the population of this country, at the very least there will be somewhere in the region of 300—that is, 300 chief executives against 152. There is a risk that that will generate a great deal more bureaucracy than exists at present in the PCTs. I am not persuaded by the level of democratic accountability of the wellbeing boards. Monitor will set a maximum tariff and then promote competition, which could easily put quality at risk for the sake of price. That view is shared by many authoritative bodies. Many questions still need to be addressed—protecting the integration of services, ensuring the accountability of Monitor and looking at the power of the NHS commissioning board. For those reasons, and a number of others that I do not have time to explain, I cannot support the Government this evening.