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The Government could not meet those expectations, and they should not have claimed to be able to do so. There is significant support among Liberal Democrats for the Government's view that the failures in manpower planning by Conservative Governments between 10 and 15 years ago led to the current shortage of specialists and other medical manpower. The cuts in the number of nursing school places was also a major mistake by the Conservatives from which we are still recovering.
The Government would have more credibility on that score if, on coming into power, when the problem was obvious, they had acted to increase medical school numbers. Instead, they waited until 1999 to start a seven-year rolling programme of increase. Similarly, they were slow to increase nursing school numbers. That is because, while rejecting Tory policy, they accepted, at least for the first two or three years, Tory spending plans. The two decisions are inconsistent, and the Government are now living with the results of their failure. They have raised expectations without delivering funding. Now the funding is being made available. We believe that it is inadequate, but compared with previous years the amounts are significant. However, that money is being wasted on the funding of agency nurses. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) has showed that in London the expenditure on agency nurses has shot up.
The Government are paying the price of their failure to deliver joined-up health and social services care, as we can see in the effects of delayed discharges, which deny resources to people trying to get health service treatment while putting people who seek to leave acute hospitals at risk of infection and of a failure to get the rehabilitation that they need. We now have a crazy system in which elderly people have to queue up to get into hospital and then are not allowed out when they have been treated. As the hon. Member for Wakefield (Mr. Hinchliffe) said, the Bill is notable for the absence of any measure to provide extra joint working between health and social services. There is no recognition that year-on-year increases in social services funding have fallen way behind increases in health funding despite the fact that social services face the same demographic pressures and staffing cost pressures.
Liberal Democrats have explained, in our reasoned amendment, why we cannot support the Bill on Second Reading. It fails to address the major issues in the health service, and it causes problems in the provision of public health services instead of solving them. As the hon. Member for Woodspring (Dr. Fox) said, it is a centralising measure but it pretends to be otherwise. As the hon. Member for Wakefield said, the Bill fails to deliver the patient and public involvement that is desired by stakeholders in the health service, by the country and by Members in this House and the House of Lords.
Mr. Jon Owen Jones (Cardiff, Central): The hon. Gentleman has just told the House that Liberal Democrat Members intend to vote against the Bill on Second Reading. What will that do to the partnership agreement in the Welsh Assembly, because the clauses that deal with Wales are promoted by his party in Wales and will fall if the Bill falls?
Dr. Harris: We hope to be able to amend those parts of the Bill that we do not support. I will go on to explain which parts we support. The prevalent idea among Labour Members that one can hitch a measure that is supported to a measure to slaughter the first born, and expect Opposition Members to support it as blindly as Labour Back Benchers do, shows their lack of a grip on reality. Our opposition is constructive.
Dr. Harris: It would not be fair to him to allow the hon. Gentleman to intervene again, but I can tell him that my hon. Friend the Member for Brecon and Radnorshire (Mr. Williams) is hoping to catch the Speaker's eye so that he can talk about the proposals that relate to Wales.
I want to concentrate on the Bill's impact on the delivery of public health. The hon. Member for Wakefield expressed his regret, which I share, that public health has fallen so far down the Government's agenda. The Secretary of State, who sadly is no longer in the Chamber, tantalisingly pointed out that the prescription and provision of statins, cholesterol-lowering drugs, can save even more lives per year than the faster delivery of heart operations in the acute sector. However, he did not say that even more lives would be saved by NHS provision of smoking cessation advice to far more people than now receive it under the Government's scheme. That shows how public health has slipped down the Government's agenda.
The United Kingdom Public Health Association expressed concerns about how the abolition of health authorities would affect public health practitioners and about the clarity of the proposed structure. The hon. Member for Woodspring read extensively from the excellent House of Commons Library briefing, so I shall do the same. The UKPHA said:
The Government must answer the charge of control freakery. The desire to control all commissioning decisions in the health service is a serious problem for a Government who claim that they are decentralising. We have already heard concerns about the provisions of clause 8, especially the proposed new subsection 3 of the National Health Service Act 1977, which will reward certain primary care trusts for what can only be described as political obedience. The last thing that patients need is commissioning based on political obedience rather than their interests, including the better delivery of health care.
Dr. Harris: I am certainly going to come on to that. It is for the Government to come up with sensible reforms, but I shall certainly explain to the hon. Gentleman which aspects of the Bill I support and what we would like to see in it. As I said, the idea of reform for its own sake is effectively sabotage; the health service does not need something that cannot be supported by those working at the coal face. No constituent, who has sent me a letter expressing concern about the failure of the health service to deliver, has begged me to reform NHS structures still more. We need an amnesty on health service reform. Sometimes undertaking no reform is better than reform for its own sake, which is equivalent to sabotage. It diverts people from trying to deliver outcomes that we all want, including the Government, by asking those individuals to reapply for their jobs in some other structure.
The Government have talked about their wish for decentralisation, but it is clear that they are not decentralising power which, in the health service, is founded on the ability to take decisions about which services to commission, the shape of service provision and which new treatments to provide. That implies that there is sufficient growth funding to allow local discretion, where the power is allegedly devolved, to make funded changes. Health authorities throughout the country have made it clear that that growth money is already spoken for in must-dos and diktats that have been issued centrally. The Government cannot claim to decentralise power when, in fact, they are centralising it. They are centralising praise by making announcements of new money centrally, but are seeking to decentralise blame, because they know that otherwise they will be held to account for failing to deliver.
The Secretary of State said that he wants to be judged on tipping the balance from central interference, as he called it, to a more patient-centred approach, and specified three measures to achieve that: improved regulation, measures to changeor, he would argue, improvepublic involvement, and the devolution of power locally. We award the Government only one out of three; we support the greater independence of the Commission for Health Improvement and, in principle, the setting up of a council to regulate health professions. However,
The Government have said that their changes will deliver £100 million-worth of savings in the context of £1 billion-worth of savings from management changes. Will the Minister allow the Audit Commission to check whether those savings have been, or will ever be, delivered? The creation of more commissioning groups, following the abolition of health authorities and the creation of strategic health authorities and more primary care trusts will lead to more bureaucracy and tiers of management in the health service.
We have some concerns about the new Council for the Regulation of Health Care Professionals. However, it is clear that best practice in each profession ought to be spread to the other professions. There is no reason why the regulation of doctors' practices should be wholly different from the regulation of the practices of nurses and professions allied to medicine. There is no doubt that practices in some areas are better than in others. If the new council has a co-ordinating role in inviting other councils to modernise and update their procedures, as has begun to take place under the order-making powers in the Health Act 1999, we welcome that.
The Government must be clear about whether there will be extensive powers to direct councils to do the bidding of the new body, given that its make-up does not amount to professional self-regulation to which, in Standing Committee recently, the Minister said the Government were committed. If we do not have professional self-regulation by dint of not having a professional majority on the new council which can issue directions to the uni-professional councils and the Council for Professions Allied to Medicine to do certain things, that may be a retrograde step. The Government must clarify the extent of those powers. It is welcome that a majority of members on the new council are not professionals. However, the Secretary of State finessed the fact that most of that majority will probably be appointed by him, so will not be independently appointed. The Government need to explain why that is not indirect political regulation of the health professions.
Finally, we have an open mind about which structures will deliver public and patient involvement. We have set tests for that involvement and want to make sure that the structures that the Government are imposing in the Bill will deliver the capabilities that they specify.