PARLIAMENTARY DEBATES HOUSE OF COMMONS OFFICIAL REPORT GENERAL COMMITTEES Public Bill Committee HEALTH AND SOCIAL CARE BILL Twenty-first Sitting Tuesday 22 March 2011 (Morning) CONTENTS Written evidence reported to the House. CLAUSE 69, as amended, under consideration when the Committee adjourned till this day at Four 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 26 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] 891 Public Bill Committee22 MARCH 2011 Health and Social Care Bill 892 The Committee consisted of the following Members: Chairs: MR JIM HOOD,MR MIKE HANCOCK,†MR ROGER GALE,DR WILLIAM MCCREA † 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 893 Public Bill CommitteeHOUSE OF COMMONS Health and Social Care Bill 894 I raise that because back in 1983, only 55% of people Public Bill Committee were happy with the NHS. Why are we having such an upheaval, and why is there this major clause? We have Tuesday 22 March 2011 had a lot of debate about Monitor, pricing, accountability and competition, but there has not been much focus outside on the issue of designation, which has just as (Morning) great an impact on the future of the national health service in terms of competition and the greater involvement of private providers. [MR ROGER GALE in the Chair] We would be grateful if the Minister explained designation to us as part of his response, as I am sure he Health and Social Care Bill is about to. Funnily enough, some people who are much more knowledgeable about the national health service Written evidence to be reported than I are having difficulty completely understanding to the House what designation means. We will explore that in our HS 108 Alzheimer’s Society debate this morning, but, fundamentally, we disagree with the clause’s provisions. HS 109 Tunstall The amendments seek to express our opposition to HS 110 John Kapp the notion of designated services. As we will no doubt HS 111 Wish discuss the wider concerns in the stand part debate, HS 112 million+ amendments 474 and 475 are specifically targeted to remove the most damaging principle of this clause: the principle that, unless an application is made otherwise, Clause 69 services are assumed to be non-designated. In effect, the amendments seek to mitigate the damage that such a DESIGNATION OF SERVICES designation regime will cause. Amendment 474 would alter the Bill so that all 10.30 am services were classed as designated in the first instance. Derek Twigg (Halton) (Lab): I beg to move The onus would then be on the commissioners to apply amendment 474, in clause 69, page 73, line 21, leave out to undesignate a service. We believe that it should be for from first ‘the’ to end of line 21 and insert ‘non-designation commissioners to prove that competition will be of of the service for the purposes of this Part. benefit to a service, not the other way round. Manufacturing ‘(1A) In the absence of an application under subsection (1) it is competition for a service should not be the default assumed that all health services are designated.’. position. I will repeat that point time and again during this debate. The Chair: With this it will be convenient to discuss People have been commissioning services for years on the following: amendment 476, in clause 69, page 73, leave the basis that they are essential, so why should that out line 23. suddenly change as a result of this provision? That represents an important structural difference between Amendment 475, in clause 69, page 73, line 24, after us and the Government. I stress that we are opposed, second ‘is,’ insert ‘not’. although we are trying to help the Government. Our approach in government was to give targeted support Derek Twigg: I welcome you to the Chair, Mr Gale. for limited competition in specific areas where there was Having previously served under you, I know that you clear evidence that it could bring demonstrable benefits are very fair and a very good Chair. I am sure that you to patients within a managed system. Strategic decisions will put us right if we step out of line in any way. I look were taken based on merit and patient need. I am forward to serving under your chairmanship. struggling to find any sign of how strategic decisions I want to start with a bit of good news from this will be made—not only under this clause, but throughout morning because there is not much in this Bill. As I was the Bill. walking in, it struck me that it was light; when the Bill We are interested to hear what the Minister has to started, it was dark. Now that there is a lot of light on say. We will explore the issue further in the clause stand the Bill, we have seen the real dangers of it, which have part debate. In contrast, I would also be interested to become more and more apparent. hear how the Minister believes allowing a range of Interestingly, in the context of these changes—the non-designated services to be shut down by providers, principle of designation—I noticed in The Daily Telegraph or stopped as a result of a provider’s failing without this morning that John Appleby from the King’s Fund being helped, could be presented as having a specific or has highlighted figures demonstrable benefit to patients. Again, the issue is “showing that two-thirds of people are now either very or quite about promoting competition, not promoting the interests happy with the state-run health care, the largest proportion since of patients. That is a theme that we will continue to the in-depth British Social Attitudes study began in 1983.” come back to during the debate on designation. The article goes on to say that, in an article in the There are many services that, if removed, would have British Medical Journal, Professor Appleby wrote: a significant adverse impact on the health of patients. It “The NHS must have been doing something right to earn this is clear from the conversations that all Members regularly extra satisfaction—something even Conservative supporters have have with their constituents that the vast majority of noticed, and something probably not unadjacent to the large rise services are important to the local population; as I said in funding since 2000.” before, if they were not, the commissioners would not 895 Public Bill Committee22 MARCH 2011 Health and Social Care Bill 896 commission them in the first instance. That all comes I intend to glue this debate down to the amendments, back to the point that we will debate later, which is that and I do not expect a ramble round the shires in the provision’s purpose is to allow failure to become between. easier, to cut services and to open them up to competition; it is not to promote the best interests of patients. Mr Burns: Mr Gale, may I surprise you by saying that As it stands, the clause will ensure that the smallest I would like to begin on a consensual note? I am in total possible number of services will be designated. Does the agreement with the hon. Member for Halton about it Minister have any idea about that number? being a pleasure to have you temporarily chairing our proceedings. I know that your wisdom will prevail, as it already has done with your announcement of the ground The Minister of State, Department of Health (Mr Simon rules on the stand part debate. I had assumed, because Burns) indicated dissent. the hon. Gentleman asked me to explain designation, that that would take place at the beginning of my Derek Twigg: I am sure that the Minister does not comments on the amendments. want to get into how regional and consortia boundaries will impact on such decisions.