Parliamentary Debates House of Commons Official Report General Committees

PARLIAMENTARY DEBATES HOUSE OF COMMONS OFFICIAL REPORT GENERAL COMMITTEES Public Bill Committee HEALTH AND SOCIAL CARE BILL Eighteenth Sitting Tuesday 15 March 2011 (Afternoon) CONTENTS CLAUSE 52, as amended, agreed to. CLAUSE 53 agreed to. CLAUSE 54 under consideration when the Committee adjourned till Thursday 17 March at Nine o’clock. PUBLISHED BY AUTHORITY OF THE HOUSE OF COMMONS LONDON – THE STATIONERY OFFICE LIMITED £5·00 PBC (Bill 132) 2010 - 2011 Members who wish to have copies of the Official Report of Proceedings in General Committees sent to them are requested to give notice to that effect at the Vote Office. No proofs can be supplied. Corrigenda slips may be published with Bound Volume editions. Corrigenda that Members suggest should be clearly marked in a copy of the report—not telephoned—and must be received in the Editor’s Room, House of Commons, not later than Saturday 19 March 2011 STRICT ADHERENCE TO THIS ARRANGEMENT WILL GREATLY FACILITATE THE PROMPT PUBLICATION OF THE BOUND VOLUMES OF PROCEEDINGS IN GENERAL COMMITTEES © Parliamentary Copyright House of Commons 2011 This publication may be reproduced under the terms of the Parliamentary Click-Use Licence, available online through The National Archives website at www.nationalarchives.gov.uk/information-management/our-services/parliamentary-licence-information.htm Enquiries to The National Archives, Kew, Richmond, Surrey TW9 4DU; e-mail: [email protected] 727 Public Bill Committee15 MARCH 2011 Health and Social Care Bill 728 The Committee consisted of the following Members: Chairs: †MR JIM HOOD,MR MIKE HANCOCK † Abrahams, Debbie (Oldham East and Saddleworth) † Morris, Grahame M. (Easington) (Lab) (Lab) † Poulter, Dr Daniel (Central Suffolk and North † Barron, Mr Kevin (Rother Valley) (Lab) Ipswich) (Con) † Blenkinsop, Tom (Middlesbrough South and East † Pugh, John (Southport) (LD) Cleveland) (Lab) Shannon, Jim (Strangford) (DUP) † Brine, Mr Steve (Winchester) (Con) † Smith, Owen (Pontypridd) (Lab) † Burns, Mr Simon (Minister of State, Department of † Soubry, Anna (Broxtowe) (Con) Health) † Sturdy, Julian (York Outer) (Con) † Burstow, Paul (Minister of State, Department of † Thornberry, Emily (Islington South and Finsbury) Health) (Lab) † Byles, Dan (North Warwickshire) (Con) † Turner, Karl (Kingston upon Hull East) (Lab) † Crabb, Stephen (Preseli Pembrokeshire) (Con) † Twigg, Derek (Halton) (Lab) † de Bois, Nick (Enfield North) (Con) † Wilson, Phil (Sedgefield) (Lab) † James, Margot (Stourbridge) (Con) † Kendall, Liz (Leicester West) (Lab) Chris Stanton, Mark Etherton, Committee Clerks † Lefroy, Jeremy (Stafford) (Con) † Morgan, Nicky (Loughborough) (Con) † attended the Committee 729 Public Bill CommitteeHOUSE OF COMMONS Health and Social Care Bill 730 “This issue of promoting and regulating competition must not Public Bill Committee hinder Monitor from the most important issue of regulating a national health service which delivers integrated, collaborative and comprehensive care.” Tuesday 15 March 2011 Health care should not be treated in the same way as the privatised telecommunications and energy industries; (Afternoon) the gamble is too great, and the outcomes far too important. Dr Hamish Meldrum, chairman of the BMA council, stated that the [MR JIM HOOD in the Chair] “consequences of failure in healthcare are far more serious than [Interruption.] Health and Social Care Bill in other industries”— The Chair: Order. May I say to some Government Clause 52 Back Benchers that I can hear a humming noise when I should be hearing the hon. Gentleman’s speech? GENERAL DUTIES 4pm Karl Turner: I am obliged, Mr Hood. It is difficult for Government Members to listen because some of the Question (this day) again proposed, That the clause, things that I have said have clearly caused them problems— as amended, stand part of the Bill. [Interruption.] That is a fact. My remarks are based on oral and written evidence to the Committee, and they Karl Turner (Kingston upon Hull East) (Lab): Before ought to listen. They should listen to the views of we adjourned this morning, I was about to explain medical experts, and to the BMA, whose members are, more about clause 52, which places at the centre of as I speak, discussing the Bill’s provisions and the effect Monitor’s role the obligation to promote competition that, in their expert opinion, it will have on the national where appropriate. In my view, the changes in the Bill, health service. and the ideology on which they are based, pose a grave threat to the national health service. Placing a statutory Dan Byles (North Warwickshire) (Con): I am curious obligation on Monitor to enforce competition creates a to know whether the hon. Gentleman is aware of how situation in which commissioners will not be able to act many members of the BMA attended the meeting today in the best interests of their patients because of a fear of and what the membership of the BMA is. The Committee costly legal challenges lurking in the shadows. would be interested to know those two things. The Government’s approach to Monitor demonstrates how ill thought out the plans are. In a clamour to roll back the state and to woo private health care providers, The Chair: Order. I am looking at the amendment the Government have set commissioners off on a long paper, but I do not see the BMA conference on the and treacherous journey, without providing them with a agenda, so it is not in order to discuss that conference— map. I am not alone in thinking that. David Owens, unless you are a member of the BMA and are attending head of commercial law at Bevan Brittan, has said that it, but not during my Committee. “under these reforms, commissioners would face a much greater risk of challenge and potential tensions between what might be Karl Turner: The hon. Gentleman knows that the best practice from a healthcare perspective and what a competitive BMA is a representative body. I understand that delegates market might result in.” will be attending that conference—[Interruption.] If the Minister is not satisfied with a legal opinion, shall we take a medical one? The British Medical Association has stated: The Chair: Order. I hope that Members heard my previous intervention. “There is a risk that it will become difficult or impossible for commissioners and providers to operate in the best interests of patients, for fear of being open to frequent and costly legal Karl Turner: Mr Hood, I was about to explain the challenges for anti-competitive practices”. words of Dr Hamish Meldrum: Monitor’s duty to enforce competition will lead us “The consequences of failure in healthcare are far more serious into a position in which attention is diverted away from than in other industries… The role of the regulator should not be achieving high-quality care so as to focus on competition. to enforce potentially damaging competition but to ensure I am fundamentally opposed to taxpayers’ money being comprehensive, high quality care and to protect patients.” used for profiteering. Our emphasis should be on National Voices rightly said in its written evidence to the promotion of increased quality of patient care. the Committee: Commissioners and providers should compete on best “One of the strongest demands of patients, service users, their quality, not on the best profit margin, and that view is families and carers is for ‘joined-up’ services. Patients want continuous shared by others. care, integrated around the patient—not, as now, to get lost in the It is particularly symbolic that Monitor’s first duty gaps, or to have to fight their way from one service to another.” under the clause is to promote competition. That comes That is yet another area in which the Government have before any reference to quality of standards in the entire over-promised and under-delivered. The Government chapter, even though quality is the most important issue talked about integration in the White Paper published in the NHS. That sentiment is shared by many interested last July, but they are failing to deliver, not slightly but parties. The Royal College of Nursing stated in its on a monumental scale. There is a basic contradiction written evidence to the Committee: between competition and integration. The Bill does 731 Public Bill Committee15 MARCH 2011 Health and Social Care Bill 732 more to fragment services than it does to connect them. William Sprigge, an expert on competition regulatory The proposed regulatory framework will not support practice, said that the delivery of more integrated care. “no trust board would want to have to close a ward or unit, with Effective relationships that have been built up over the consequent impact on the provision of care, to pay a multi years through co-operation and trust will be swept away million pound fine for price fixing.” in an outbreak of litigation and European intervention. As Monitor stamps down its new economic regulatory Litigation lawyers, as my hon. Friend the Member for regime, mistakes are bound to be made. Litigation will Leicester West rightly said, will be rubbing their hands result and continue for some time afterwards. That at the prospect of taking on this legislation. What means that budgets will be spent on paying fines for happens when arrangements between local provider breaching competition law instead of improving quality and commissioner, which have worked so well in the of care. Public money will presumably be diverted away past, are subjected to anti-competition challenges? It is from spending on improving quality to enforcing a worth reminding the Committee and the Government regime that will drive down patient care, fragment services of what the experts have said. Diabetes UK said that and prevent commissioning in the interests of patients. “duties to promote competition raise concerns about the impact In order to deal with its new role, Monitor will need to this will have on the delivery of integrated services, and on massively expand its staff, resulting in another substantial commissioners and their ability to work collaboratively with cost to the public purse.

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