Mr.
O'Brien: Amendment 4 would add a duty for NHS bodies to
have regard to the core principles of the NHS which would, by
amendments 5 and 6, be enshrined within the legislation. Amendment 5
lists the core principles
of the NHS according to its plan. Amendment 6 sets out the redacted core
principles as they now appear in the NHS constitution.
There is a
recurrent theme in the regulatory impact assessment, with phrases such
as
“The
legislative duties reinforce the benefits of the Constitution, reducing
the likelihood that these benefits will be eroded over
time.” That
is in paragraph 7 of the cover note. It also
states: “The
constitution should mitigate the risk of the erosion of core
values”. It
is unclear whether this is an adviser extending the assessment’s
word count, or if it is a slightly unnecessary and unfortunate attempt
to suggest that the core values of the NHS would be under threat in
advance of a general election and another Government. We would
certainly argue that this is unjustified.
It is clear
that the Government themselves have been responsible for the erosion
of, if not the values that lie behind the core principles, at least the
core principles themselves. Nine years ago the NHS plan set out
10 NHS core principles, which were endorsed by 25
organisations representing both NHS staff associations and patient
groups. In that intervening period, those have become increasingly well
regarded, enforced and emphasised. They are good principles and the
official Opposition are committed to enshrining those principles in
legislation, hence amendment 5.
Unfortunately,
the Government have chipped away at those core principles for the last
nine years, which, inevitably, is a cause for concern. My right hon.
Friend the Leader of the Opposition has consistently confirmed our
commitment that, under any incoming Conservative Government, the NHS
will continue to be a public service free at the point of need, with
equality of access based on need, not ability to pay. I am keen that
the Government should seek to support
that. In
the December 2006 consultation on the core principles of the
NHS—which we have committed to enshrining in legislation and
which were referred to during our debate on the previous group of
amendments—undertaken by the former Minister, now the Secretary
of State for Health, the Government committed to the principle
that “Public
funds for healthcare will be devoted solely to NHS
patients.”
I heard what the
Minister had to say and intervened on him in relation to his example of
prescriptions. I wanted to ensure that we fully understood this in
light of the Government’s own review, the report received and
the Government’s reaction in relation to top-ups, which had
caused great anxiety to patients and Members throughout the House, not
least on the Government’s Benches. This principle, which appears
in paragraph (f) of amendment 6, remains notable by its absence. As a
sub-point to principle 6—I am glad to say that we had a hand in
making this happen—the Government reintroduced the
phrase: “Public
funds for healthcare will be devoted solely to the benefit of the
people that the NHS serves”.
“People that the
NHS serves” is, of course, a much less secure category than
simply “NHS patients.” I am sure that will not be lost on
hon. Members.
The original
core principle 4, that the NHS will respond to different needs of
different populations—in truth, communities—has fallen
off the agenda in such specific terms. It is important that we
recognise that different communities and those with different genetic
antecedents have different health needs. It is of particular concern
that this original core principle of recognising the response required
by the NHS for different needs in different communities has
disappeared from the Government’s stated position and agenda. I
am not making a party political or contentious point, but it just
happens to be at a time when all of us across the House need to join
shoulder to shoulder in resisting anything that could give credence to
some of the most appalling, outrageous and obnoxious electoral
approaches of people who stand for a party such as the BNP, where they
are looking for excuses to underpin their racist, class-based,
anti-communities approach. I hope that the Government will consider
rowing back from this area because the original core principle 4 needs
to be looked at, particularly in the light of that political context,
let alone the health
context. Extraordinarily,
core principle 6,
“that the NHS
will support and value its
staff” has
been ditched without apparent replacement. I need hardly say more: it
is just extraordinary. I will listen carefully to what the Minister has
to say on that, because it seems to us to be an appalling
omission. The
original core principle 9 specifically and explicitly addressed health
inequalities. That phrase does not appear in the constitution’s
core principles. It may be simply to hide the Government’s
embarrassment over their failure, over time, to reduce health
inequalities, but that remains a broader debate for another day and I
can assure the Minister that we will continue to have that
debate. The
Government’s failure to secure compliance with the final core
principle of the NHS plan, on confidentiality, has, I am sorry to say,
become legendary. It is no surprise, but it is to the
Government’s shame that this, too, has fallen off the agenda. It
is right that the impact assessment should be concerned about the
ability of a Labour Government to chip away at the principles of our
NHS. We have remained committed to them while the Government have
consulted on them, through the NHS plan, have set up a new set for NHS
Choices and now a new set in the constitution. It is precisely for this
reason that the principles that were in the original NHS plan, as we
have consistently proposed, ought to be in the
Bill. In
a fit of generosity to the new Minister, I have included the core
principles as laid out in the NHS constitution in amendment 6. If he is
unable to support his Government’s original proposals, by way of
supporting amendment 5, the NHS plan core principles, I hope that he
will at least be happy to accept what is proposed in amendment 6. I
hope that sets the scene for this very important series of
amendments.
Mr.
Mike O'Brien: Amendments 5 and 6 place principles of the
NHS in the Bill, with amendment 5 listing principles from the NHS plan
published in 2000 and amendment 6 abbreviating the principles published
in
the NHS constitution. Amendment 4 would require the bodies listed in
clause 2(2) to have regard to these
principles.
Members of
the Committee will be aware that clause 2 already sets out a
requirement to have regard to the constitution. This requirement
relates to the whole of the constitution, including its principles. It
is therefore unnecessary to restate here the need to have regard to the
principles. We
have not lost sight of some of the principles set out in the NHS plan,
so I can reassure the hon. Gentleman that no principles from the NHS
plan have gone missing from the constitution at all. We do not want
that to happen. We engaged key stakeholders extensively when drawing up
the constitution and the results of that work allowed us to refine the
principles set out in the NHS plan. Where they do not appear as
principles, they are reflected elsewhere in the constitution, either as
pledges or as rights. For example, the principle around valuing staff
is reflected throughout the constitution, in its pledges to staff and
in the third principle, which sets out the importance of the education,
training and development of
staff.
Sandra
Gidley: The Minister makes an interesting point, but I was
very taken with the arguments of the hon. Member for Eddisbury. Is the
Minister saying that the public have no regard to health inequalities?
That seems to have been eroded from the original NHS
plan.
Mr.
O'Brien: Health inequalities are certainly important and
that is why we have an Equality Bill, which the House wanted to see
introduced. Equalities, in health and in a range of other things, are
part of the Government’s wider agenda. I reassure the hon. Lady
that the Government continue to believe that equality in the health
service is enormously important. For the very reason that we are
including the health service in the Equality Bill, I hope that she is
reassured that that remains the case. Equally, the principle around
public funds being devoted solely to NHS patients has not been lost. It
has simply been stated differently in order to move away from the idea
of people who use NHS services being classified as NHS patients. All
those who use NHS services are not necessarily NHS patients. They may
be using a service to get information and may not regard themselves as
accessing an NHS service as a patient. They may merely be seeking to
obtain information about how that service operates. They may be seeking
to access it for all sorts of reasons, even to enter into a contract. A
doctor seeking, for example, to work with the health service is not
engaging as a patient; he is engaging as a doctor and therefore is in a
different category. Some of the wording, therefore, has been changed.
The sixth
principle: “Public
funds for healthcare will be devoted solely to the benefit of the
people that the NHS serves”,
is an important
one.
The outcome
of the review into top-up payments was that public funds can be used
only for the benefit of NHS patients and not to subsidise private
health care. Following the review, the Government clarified that NHS
care should not be withdrawn when a patient wishes to purchase
additional private care separately from their NHS care. There should
not, however, be any mixing of publicly and privately funded care. That
is an important point. We need to look at this in relation to other
areas of the health service to be sure that that is properly
recognised.
When we
consulted on the draft constitution last summer, our consultation
document specifically explained how each of the 10 NHS plan principles
had been incorporated into the constitution. We now have a set of
principles that, after full consultation, have the support of
patients’ groups, the public and the staff. The large majority
of respondents to the consultation thought the principles were
articulated in broadly the right way. A large number of improvements
were suggested and the final published version of the NHS constitution
reflected these comments, as I have already indicated to the hon.
Member for
Eddisbury. It
is also important to remember why we have chosen not to include any of
the NHS constitution in the Bill. As I have indicated, we do not want
to create a lawyers’ charter. This is why a declaratory, not a
legal document is important, and why we are cautious about following
the route suggested by the hon. Gentleman. My concern
is that we would be doing exactly what I thought we had
agreed in the last debate we both wanted to avoid, which is to create a
lawyers’ charter so that we create new routes into the NHS and
we end up with judges determining NHS priorities rather than the NHS
structures.
Enshrining
the NHS principles in primary legislation sets them in stone until that
legislation is changed. I am firmly of the view that the principles are
enduring and it is certainly not my intention for them to
change in any significant way, but I also believe we need a
degree of flexibility as the NHS grows and evolves. These
amendments do not allow for that flexibility. There is a
range of new services and a range of new demands from patients and we
need to be able to reflect that in a positive
way. We
have listened to the Opposition’s concerns on these points while
the Bill was in another place and I believe we have reached a sensible,
balanced position in relation to the constitution. As the Bill stands,
it allows parliamentary scrutiny of any changes to the
constitution’s principles by addressing those changes in
regulations, and they will therefore have to be brought before the
House. This solution avoids the dangers of placing them in the Bill,
which could lead to precisely the problems that I thought both the hon.
Gentleman and I agreed we wanted to avoid.
Given my
reassurances, I hope the hon. Gentleman will be able to withdraw his
amendment.
Mr.
Horam: Will the Minister clarify my thinking about one
particular aspect of this which is referred to in amendment 6,
paragraph
(g): “the
NHS is accountable to the public, communities and patients that it
serves.” He
is familiar, as we all are, with our local involvement networks, which,
on behalf of local communities, can scrutinise what is going
on in primary care trusts or trust hospitals. Are their rights
enshrined in the constitution and principles of the NHS or are they
susceptible to a degree of local discussion? For example, do they have
the right under the constitution to go to a board meeting, ask
questions and receive the agenda beforehand? Equally, is it their right
to inspect a hospital with 24 hours’ notice? I want to be clear
whether this is laid down in the constitution or whether it is subject
to any local discussion and negotiation.
11.45
am
Mr.
O'Brien: With regard to the rights of LINks, among other
organisations, which we will be discussing later in relation to
amendment 12, we have agreed in relation to any changes in the
constitution to consult broadly, including organisations that represent
patients. The rights of groups to visit a hospital, to access papers,
to ensure that they are fully informed about what is happening in the
NHS, do not need to be enshrined in the constitution. They arise as a
result of other requirements, which are laid down in regulations and in
guidance from the Department. A number of rights exist for doctors,
nurses, patients’ organisations and other groups. They do not
all have to be in the constitution.
The
constitution is the skeleton structure on which other things have to be
attached, rather than a document delineating all the rights that people
may have. It is a broad declaration of principles. I hope that deals
with the hon. Gentleman’s concerns. Any rights that LINks,
patients’ groups and other organisations may have will remain
the same, to the extent that they may refer to the constitution and say
to a PCT, “Make sure you are complying with your own
constitution.” They will be able to do that, so there will some
strengthening of rights, but there will be no new ability for
organisations to claim rights that they do not currently have. I hope
that deals with the point. We take the view that the legislation is
properly drafted and I hope that hon. Members will be able to support
it. Mr.
Andrew Turner (Isle of Wight) (Con): My problem
lies with amendments 5 and 6. Which of those applies, or does neither
apply? Subsection (3)(a) in amendment 5
states: “the
NHS will provide a universal service for all based on clinical need,
not ability to
pay”, while
subsection (3)(a) in amendment 6
states: “the
NHS provides a comprehensive service, available to
all”. Is
the Minister saying he does not accept either because they are both
wrong or that one of them is right and one is wrong? What is his
understanding of these two
amendments?
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