This Week in Westminster - September 5th - 8th

Parliament returned this week for a short interlude before the party conferences. As a consequence the timetable is jam-packed with significant pieces of government legislation. This week saw the return of the Health and Social Care Bill, a not uncontroversial bill in itself, but with the added heat generated by amendments on abortion counselling tabled by Nadine Dorries MP. Two Tory MPs seem to challenge David Cameron in Prime Minister’s Questions and I was able to make a contribution to a discussion on Libya.

• Libya (September 5th) - By way of background to this, the Treasury is in danger of demanding too much for offering our services to places like Libya, thereby pricing ourselves out of the market and losing important opportunities to influence.

Mrs Madeleine Moon (Bridgend) (Lab): The Prime Minister has rightly praised the professionalism, skills and ethos of the 2,300 service personnel. If Libya is to take over responsibility for its own security so that those service personnel can return to base and to other duties, will he ensure that, in financial terms, the training that we provide will help to build a new Libyan army, air force and navy that are competitive with those of other countries, so that we can pull our own service personnel back? If we can provide that training, we can build a new relationship between our armed forces.

The Prime Minister: Certainly we will make available our advice, services and help for the new Libya. As I have said, we must allow the Libyan people to choose what they want to do, rather than force things on them. I do not think we should have the attitude that because we have helped to liberate Libya we should therefore get some sort of automatic preferred status. We should do it on the basis of what we have to offer, and on the basis of all the normal rules and regulations that we bring to this.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110905/debtext/110905-0001.htm#1109054000001

• Health and Social Care Bill (September 6th) – while health is a devolved matter in Wales, this Bill has generated a lot of debate and has the potential to have a significant impact on the way the NHS operates in England. The Bill was famously sent back to committee for further consideration, producing reams of amendments and further layers of complication. Many of these relate to changing the terms used rather than the contents of the Bill, which produced several pages of the same amendment repeated over and over again. Mr. Speaker was forced to explain that there is no other means of doing this. That aside, one of the key concerns is the trend towards competition and privatisation.

461, page 25, line 11, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
462, page 25, line 13, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
463, page 25, line 22, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
464, page 25, line 24, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
465, page 25, line 29, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’.
466, page 25, line 40, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
467, page 25, line 43, leave out ‘commissioning consortia’ and insert ‘clinical commissioning groups’.
468, page 27, line 2, leave out ‘commissioning consortium’ and insert ‘clinical commissioning group’

Frank Dobson (Holborn and St Pancras) (Lab): I believe I was the first person to expose the fact that on average the private sector was paid 11% more per operation than the NHS was getting for the equivalent operation. I shall take no lessons from anybody when it comes to opposing some of the daft things that went on. I did oppose them and I am proud to have done so. What is being proposed now, however, goes far beyond that. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) who has a great deal of knowledge in these matters has pointed out, there is scarcely any evidence from anywhere in the world to show that a competitive system delivers better health care than a collaborative system.

To ask the essentially collaborative health care system in this country to turn over to being competitive is a bit like asking the Meat and Livestock Commission to promote vegetarianism: it is simply not what people want to do; it is not their approach and nor should it be. It remains the case that Monitor is still rigged in favour of promoting competition. Let me point out—hopefully without putting my glasses on—that clause 58(3) states:

“Monitor must exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services for the purposes of the NHS which is against the interests of people who use such services.”

However, it does not say that “Monitor must exercise its functions with a view to preventing competitive behaviour in the provision of health care services which may be against the interests of the people who use such services”. Apparently, then, there is a basic, intrinsic and fundamental assumption that competition must be beneficial and non-competition must be harmful. If the Government say that Monitor is neutral, it should be given a neutrality in respect of competition and non-competition. As I think the hon. Member for Peterborough (Mr Jackson) would agree, the unfair competition of some of the independent treatment centres was harmful to and threatened the services provided by neighbouring NHS hospitals. There is clear evidence here of problems within the private sector.

I recall that, a few years ago, United Health—a subsidiary of the US United Health—took over three GP services in my constituency. It bid that it could provide the range of services for less than the local GPs, so it got the contracts. It has not complied with all the conditions that were set, but in the end, the primary care trust decided that it could not take it to court because it would be such a lengthy and expensive exercise and it feared that the PCT might not win. Not content with that, United Health recently announced that it was selling the franchise to another private outfit. It did not consult the staff. It did not consult any elected local representatives—neither myself nor councillors. Above all, it never consulted the patients. These private sector outfits regard patients as part of the chattels that they can dispose of to maximum benefit and maximum profit.

That illustrates the fact that if we are to have contract-based provision of services, a huge amount of lawyer effort will be put into trying to draw up watertight contracts. What one lawyer thinks is a watertight contract, another lawyer will make a leaky contract by puncturing a hole in it, and we will go over to the system in the United States, where zillions of dollars are spent on court challenges or settlements with the providers of health care.

Furthermore, there is virtually no major American supplier of health care that has not been indicted for defrauding federal taxpayers, city taxpayers, state taxpayers, doctors or patients—and sometimes all five. I thus asked the Secretary of State whether he would rule out giving any NHS contracts to any organisation that had been indicted for defrauding people in another country. He gave me about a page-long answer, which could be summarised as, “No, he would not rule them out.”

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110906/debtext/110906-0002.htm

• Abortion counselling (September 7th) – the debate of amendments to the Health and Social Care Bill produced some extraordinary exchanges, not least of which one between Nadine Dorries MP and Frank Field MP. Mr. Field had originally put his name to the amendment, but apparently discovered only as the debate got underway that his name had been removed.

Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): The hon. Lady is making an excellent speech and has outlined the fact that there is adequate provision for counselling in the status quo. Doctors, nurses and other medical professionals who must deal with such situations every day have adequate measures in place, as the Royal College of Obstetricians and Gynaecologists has outlined. They do not look only at the medical consultation, but at the whole patient, as we have heard. If that means that counselling is required, they will ensure that their patient gets it. Does she agree that this is not the place for the amendment, which serves no purpose, and that we need to get on and debate the Bill?

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.
As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.

There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110907/debtext/110907-0002.htm

• PM under fire (September 7th)

Nadine Dorries (Mid Bedfordshire) (Con): The Liberal Democrats make up 8.7% of this Parliament and yet they seem to be influencing our free school policy, health and many issues including immigration and abortion. Does the Prime Minister—[ Interruption. ]

Mr Speaker: Order. The question from the hon. Lady will be heard.

Nadine Dorries: Does the Prime Minister think it is about time he told the Deputy Prime Minister who is the boss? [ Interruption. ]

Mr Speaker: Order. I wanted to hear the question, but I want to hear the Prime Minister’s answer.

The Prime Minister: I know that the hon. Lady is extremely frustrated about the—[ Interruption . ] Perhaps I should start all over again—[ Interruption. ] I am going to give up on this one.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110907/debtext/110907-0001.htm#11090754000008

Mark Reckless (Rochester and Strood) (Con): The Prime Minister has listened to Liberal Democrat colleagues by delaying police elections until November next year. Will he now listen to Conservative colleagues and take the opportunity to hold a referendum on Europe?

The Prime Minister: That is an ingenious way of putting the question. As I explained yesterday, I want us to be influential in Europe about the things that matter to our national interest—promoting the single market, pushing forward for growth and making sure that we get lower energy prices. Those are the things that we will be fighting for, but I do not see the case for an in/out referendum on Europe. We are in Europe and we have got to make it work for us.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110907/debtext/110907-0001.htm#11090754000008