Health and Social Care Bill

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Mr. Hilton Dawson (Lancaster and Wyre): Is it not a failing that the Opposition are unable to take on board the Government's commitment to high standards and co-operation rather than competition?

Mr. Hammond: The hon. Gentleman, as so often before, uses the words, but the Bill does not provide the mechanism to ensure that co-operation. I remind him that the note circulated by the Minister says that 25 per cent. of NHS bodies will be categorised as green. It will be a competitive process. If one trust is helped to improve and to become categorised as green, it will lessen another trust's own chance of falling within the green category.--[Interruption.] The hon. Gentleman can pull whatever face he likes. If we tell a group of people that only 25 per cent. of them will be eligible for the first prize, it is unlikely that they will find it sensible to devote a significant part of their energies to helping their competitors to be in that 25 per cent.

Lorna Fitzsimons: Will the hon. Gentleman accept my experience of the hospitals in my health authority, which is that all the professionals were glad to get rid of the competition imposed by the Conservative Government? The whole ethos of the NHS based on co-operation beyond the boundaries of each hospital's physical environment.

Mr. Hammond: The hon. Lady is making a case against the clause. Through the traffic light scheme, the Government are perniciously and artificially seeking to re-impose the competition that they said they wanted to end in the NHS. I do not believe that that will encourage NHS green organisations to second their staff to help those categorised as failing. I do not think that the Government believe it either. I think that they intend to look to outside bodies and private sector consultants and managers, as they have in education, to take over and reinforce the functions of failing NHS trusts. If that is wrong, and the Minister wants to say that the Government will not use the powers under the clause to appoint private sector management teams to run health authorities or trusts designated as failing, I shall be happy to give way.

Mr. Denham: I shall deal with the matter later.

Mr. Hammond: The Minister does not want to make that statement. Although the Secretary of State would understandably prefer an NHS solution—that does not mean that he believes that such a solution can be delivered—he has refused to rule out the possibility of private sector involvement using his powers on the running of NHS trusts under the clause.

The amendment proposes a departure from the way in which the NHS has been run. It would have significant consequences for the trusts and health authorities involved and would, I hope, be used rarely, such as when public scandal already surrounds the activities of a hospital, trust or health authority. In such extreme circumstances, it would be entirely appropriate and proper for Parliament to have the opportunity to scrutinise the proposed intervention order before it was made, and for it to be subject to the approval of both Houses of Parliament. That is what the amendment seeks to achieve.

Dr. Brand: In my earlier contributions, I did not have an opportunity to declare my interests as a general practitioner contracted to the national health service, and as someone who sat on health authorities for many years until I was booted out by the previous Government on the ground that I worked for the NHS and knew something about it.

These interesting amendments show a difference in emphasis between the two Opposition parties. It is right for the Secretary of State to have intervention powers; Secretaries of State have always had such powers. Health authorities are not democratically accountable, except through the Secretary of State. Had the Government adopted our policy of putting health under a locally accountable structure—a local democracy—intervention would be totally exceptional and might need a positive resolution from the House of Commons. However, we are considering a health authority or trust acting as an agent of the Secretary of State in providing a service. If such a body fails to provide the service and is not amenable to a co-operative process of correcting that failure, it is right that powers of intervention should exist.

The Secretary of State should be accountable for taking the powers in question, but it would not be practical to withhold the powers until the decision had been debated in both Houses of Parliament. That would enable a rogue authority to run riot for three months, which would not be acceptable. The Secretary of State should be accountable for his or her decisions, but to bind such a decision to a debate in Parliament before it could be implemented would clearly be nonsense.

We have had some discussion of the traffic light system and league tables. I hope that we shall be able to return to that topic, which seems to me to sit better with the next group of amendments. Amendment No. 41 would not only strengthen democratic accountability, but would be practical. I should not want to deny the Secretary of State the power to sort out something that had gone seriously wrong.

Mr. Hammond: Perhaps I have misinterpreted amendment No. 41, but it seems to me that it would achieve nothing. The order would in any case be made in a statutory instrument, subject to annulment, and would therefore be debatable after the event. Amendment No. 61 was intended to provide for debate before the action was taken.

Dr. Brand: Exactly. We are realists. The hon. Gentleman clearly has no ambition ever to be Secretary of State for Health. He suggests that we should tie the hands of the Secretary of State to such an extent that he could not intervene unless both Houses were sitting. That is clearly nonsense.

Mr. Hammond: The hon. Gentleman is contradicting himself. He said clearly at the beginning of his remarks that the Secretary of State already has substantial power to intervene, which is true. We are concerned about the additional and exceptional powers that clause 16 would grant him. There would be nothing to prevent the Secretary of State from using powers under other health legislation. Only the additional power under clause 16 would be subject to positive resolution.

Dr. Brand: I have talked about paranoia before. I see the intervention powers as a tidying up of many little powers that already exist, and as meshing with the more overt, and perhaps clearer, way in which the Secretary of State can direct policy in the national health service. I see nothing wrong with that. My only concern is that the status of health authorities and trusts, the commissioning bodies and providing bodies will again be fudged. Perhaps some of the powers should be used by the Secretary of State only in conjunction with a commissioning body. Unless the commissioning is right, the trust cannot be expected to perform. There is a risk that the Secretary of State, acting from the centre, will interfere with mechanisms against the will or policy of the commissioner of the service. I hope that the Secretary of State will provide an assurance that powers will be taken against trusts only in conjunction and consultation with the health authorities responsible.

Mr. Desmond Swayne (New Forest, West): I will take literally the strictures that my hon. Friend the Member for Runnymede and Weybridge gave the Committee earlier about being brief. I will not attempt to reiterate the case that he so ably made for the amendments, nor refer to the fact that the Liberal Democrat Members associated themselves with an agenda that increasingly allows the Secretary of State to manage all aspects of the health service. I shall, however, thank my hon. Friend for his kind words of welcome.

Hon. Members who have served with me on other Committees will know that I have never brought, or pretended to bring, any great wisdom to a Committee: I merely ask questions. I am unlikely to have been transformed by the announcement made this morning by my right hon. Friend the Leader of the Opposition.

My first question for the Minister is whether subsections (2) and (3) raise a rights issue. I note that the Secretary of State has given his imprimatur to the Bill under the Human Rights Act 1998, but a rights issue is raised nevertheless. I shrink from saying human rights: I have always thought it unnecessary, because all rights are human rights, to distinguish between the rights of men and the rights of orang-utans. Subsections (2) and (3) allow the Secretary of State to deprive the members of the board and officers of their livelihood and occupations. What right of appeal will they have?

11.30 am

Dr. Brand: Is the hon. Gentleman suggesting that people serve on boards merely because it is a source of income? I thought that the remuneration was modest, in recognition only of the time that they had given.

Mr. Swayne: No, the Bill's provisions go rather wider. It speaks not only of members but of

    those specified in the order.

That will affect people's livelihoods. Even if it does not, should someone be deprived of a position on the board merely on the fiat of the Secretary of State and without recourse to the other provisions of clause 16? Amendment No. 62 would allow scrutiny of the Secretary of State's decision by the highest tribunal of the land.

Mr. Denham: I congratulate my near neighbour, the hon. Member for New Forest, West, on his promotion. He has already shown that he will be an interesting and lively member of the Opposition Front Bench.

The hon. Member for Runnymede and Weybridge suggested that clause 16 was a draconian measure, but it is possible to envisage even more draconian measures. For instance, the Secretary of State could take to himself the power not merely to change the management of the trust but to dissolve it entirely. However, he cannot take that power because he was given it under the previous Administration when the trusts were set up. The power to dissolve trusts entirely is not subject to parliamentary control. The only requirement is for prior consultation, which can be dispensed with in urgent cases. The actions of the previous Government do not allow the hon. Gentleman to make a powerful case. However, it is reasonable to ask how the Government anticipate using those powers.

It would be useful to clarify the few minor points raised during the debate. Questions were asked about rights of employment. If a trust has new management, the employees of the trust will remain employees. Employment matters are for the trust to resolve as the employer. Different issues arise for board members. At the moment, the Secretary of State can dismiss non-executive directors of boards because they are not in an employment relationship with the trust or the health authority.

I struggled to understand the curious argument about introducing a competitive element back into the national health service. By awarding trusts green-light status, we will be rewarding with greater autonomy and greater freedom the best performing trusts, and setting the benchmark to which the rest of the NHS should aspire.

The hon. Member for Runnymede and Weybridge will have noted in the consultation paper circulated to the Committee and more widely that we believe that, initially, 25 per cent. of trusts will be in the green-light category. By indicating that the figure may not always be 25 per cent., we have built in flexibility, so that we do not have a rigid system in which some people have no incentive to improve and others who improve massively none the less cannot enjoy the greater rewards and the greater autonomy. We need that flexibility in the system, and have said that we will provide it. There is no bar to one successful health organisation co-operating with another that needs a helping hand with a problem.

 
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Prepared 23 January 2001