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Health and Social Care Bill

Volume 541: debated on Tuesday 28 February 2012

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Health and Social Care Bill following a letter from the Deputy Prime Minister to MPs and peers and the Government’s response.

I am glad to have this opportunity again to set out the purposes of the Health and Social Care Bill. It will give patients more information and choice, so that they can share in decision-making about their care. It empowers front-line doctors and nurses to lead the delivery of care for their patients. It cuts out two tiers of bureaucracy and strengthens the voice of patients and the role of local government in integrating services and strengthening public health.

The values of the Bill are simple: putting patients first, trusting doctors and nurses, focusing on results for patients and maintaining the founding values of the NHS. We are constantly looking to reinforce those values, strengthening the NHS to meet the challenges it faces. We know change is essential; we will not let the NHS down by blocking change. Throughout the development and progress of this Bill, we have engaged extensively with NHS staff, the public, and parliamentarians.

The Health and Social Care Bill is the most scrutinised public Bill in living memory—[Interruption.] With over 200 hours of debate between the two Chambers and 35 days in Committee, we have ensured that Members and peers have had every opportunity to examine, understand and amend the Bill to—[Interruption.]

Order. I granted this question because I want Members to have the chance to scrutinise the Government of the day, but courtesy dictates that the Secretary of State’s statement must be heard.

Thank you, Mr Speaker.

We have made this legislation better and stronger. We have made significant changes to the Bill, including in response to the NHS Future Forum’s work and we have been open to any further changes that would improve or clarify the Bill. For example, so far in the Lords, the Government have accepted amendments tabled by a number of Cross-Bench, Liberal Democrat and Labour peers.

Yesterday, my right hon. Friend the Deputy Prime Minister and Baroness Williams wrote to their Liberal Democrat colleagues explaining their support for the Bill, with those changes and some further amendments they wish to see. They said, for example, how we must

“rule out beyond doubt any threat of a US-style market in the NHS”.

I wholeheartedly agree. The Bill is about quality, not competition on price. It will not permit any NHS organisation to be taken over by the private sector. It will put patients’ interests first. The Bill does not permit any extension of charging, and care will be free, based on need. Where the doctors and nurses on the ground know that competition is in the best interests of their patients—where it is based entirely on the quality of the care and treatment provided and not in any way on the price of that care and treatment—then competition can play an important role in driving up standards throughout the NHS.

We will not see a market free-for-all or a “US-style” insurance system in this country. I believe in the national health service. I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs. We—and I do mean all of us on the Government Benches—are using the debates in the Lords further to reassure all those who care about the NHS. I am grateful for this chance to reassure all my hon. Friends regarding the positive and beneficial effects of debate in the other place and about the work we are all doing to secure a positive future for the NHS.

On Friday, the Prime Minister promised there would be no more amendments, and yesterday lunch time the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) said that the whole Government backed the Bill as it stood, but hours later the Deputy Prime Minister called for changes to a flagship Bill that he has supported all the way. The Government appear to be in complete disarray—or perhaps this was pre-agreed coalition choreography for the Deputy Prime Minister to save face. Either way, this House is entitled to ask, “What is going on?” The NHS matters too much for us to allow it to be carved up in the unelected House in cosy coalition deals, so we are grateful, Mr Speaker, that you have brought Ministers here today to start providing some answers.

First, on the process, will the Secretary of State tell the House when he was first made aware of the Deputy Prime Minister’s letter? Was he consulted about its contents in advance and did he consent to the apparent change of policy or was he overruled by the Deputy Prime Minister? Who is in charge of health policy? Is anyone in charge?

Secondly, on policy, will the Secretary of State update the House on the precise detail of the changes that the Deputy Prime Minister is seeking in the five areas he identifies? For instance, we hear that the Deputy Prime Minister, having previously defended the 49% private patient income cap for foundation trusts, now wants “additional safeguards”. What are those safeguards? Are the changes still under discussion or do they now represent Government policy? Yesterday, the Liberal Democrats played up the changes, but the Secretary of State’s Department has dismissed them as minor. Is his view the same as ours that the amendments do not affect the substance of his Bill but rather are cosmetic changes designed to make the Deputy Prime Minister look good in advance of his spring conference?

The Prime Minister has been clear: this Bill is about competition at the heart of the health service. The Deputy Prime Minister has supported it all the way. Are not these just empty gestures designed to save face? This is a bad Bill that cannot be amended. Last week, the president of the Lib Dems spoke for his party when he admitted that the Bill should have been dropped. Does that not explain what this posturing is all about? In their heart of hearts the Liberal Democrats hate this Bill but have not had the guts to stand up to the Prime Minister and say so. Both coalition parties are putting their political pride before the best interests of the NHS. Is it not time for them to do what they said they would do at the start—listen to doctors and nurses and drop this Bill?

I am not sure the right hon. Gentleman even read the Deputy Prime Minister’s letter, judging from what he has just said. I will tell him exactly what the process is. The process is for detailed discussion in another place. There were 15 days of debate in Committee in another place. It is the habit in another place not to amend the Bill in Committee, but to use those debates in Committee as a basis for amendment on Report. The process is straightforward. My right hon. Friend the Deputy Prime Minister, together with Baroness Shirley Williams, explained to their Liberal Democrat colleagues some of the amendments on which we have been working together in order to make sure that there is further reassurance. [Interruption.] That is literally true.

Let me put the right hon. Gentleman right about something. What is at the heart of the Bill is improving the quality of care for patients. I note that he did not quote me or represent that he was quoting me. I have never said that competition is at the heart of the Bill. Competition is a means to an end, not an end in itself. The purpose of the Bill is to achieve quality. Where competition enables us to deliver better quality for patients, we should use it. Where integration of services and an absence of competition is in the interests of patients in delivering quality, that is the basis upon which the NHS should proceed. The Bill has been tremendously strengthened and is now a long-term sustainable basis for the NHS to deliver the quality of care for patients that we are looking for, while maintaining all the values of the NHS.

Has my right hon. Friend yet been able to understand how it can be that a party which, when in government, promoted practice-based commissioning that involved GPs in commissioning, promoted private sector investment in NHS institutions, and promoted the commissioning of care from private sector providers where that was in the best interests of patients now thinks all those principles undermine the national health service to which he, we and presumably the Opposition are still committed?

My right hon. Friend makes extremely good points. It is interesting that the right hon. Member for Leigh (Andy Burnham) appears to be trying to represent us as not agreeing about matters. He is chronically incapable of agreeing with himself. In June 2006 the then Prime Minister, Tony Blair, said that what the NHS needed in future was foundation trusts, practice-based commissioning, more involvement for the private sector and payment by results. The thing is that Labour in office did not achieve any of those things. It is only through the mechanism of the legislation that we are putting together that we are going to enable the NHS to achieve those things in a way that does not entail all the difficulties that Labour had, such as getting the private sector involvement with the NHS wrong. We are going to get those things right.

Does the Secretary of State agree that the Salisbury convention requires the House of Lords not to reject a measure if it has an electoral mandate? As all the parties in the House were mandated not to totally reorganise the national health service, would it not be wholly proper for the Liberal Democrats in the Lords to have some guts, join with Labour and Cross Benchers and vote the whole measure down?

The right hon. Gentleman is completely wrong about that. Perhaps he was not here last Wednesday when we debated health matters. [Hon. Members: “He was.”] Well, then he did not listen. I set out very clearly how the Bill was responding to the manifesto mandate that we in our party had, and it was a manifesto mandate that the Liberal Democrats brought to the coalition Government, not least in relation to the role of local government, bringing greater democratic accountability, which is precisely how some of these things have been achieved. If the right hon. Gentleman is talking about a mandate in the Lords, he might like to tell his colleagues that at the last election his party was elected on the basis of supporting foundation trusts, for example, to be able to be free to increase their private income.

Order. If I am to accommodate anywhere near the level of interest in this important matter, I shall require brevity—to be led, as so often, by Mr John Redwood.

Am I right to tell my constituents that the purpose of this reform is to give more choice of care to patients, and to give more power to GPs to deliver better free treatment?

Given that the right hon. Gentleman inherited an NHS with record short waiting times, record high public satisfaction and improving competitiveness, does he ever in his darkest moments wish that he had not embarked on this damaging and costly upheaval?

At the last election the average waiting time for in-patient treatment was 8.4 weeks. In December 2001, when the most recent data were published, it had come down to 7.7 weeks. The right hon. Gentleman might like to reflect on the fact that the number of people waiting more than a year for treatment in the NHS is now more than half what it was at the last election.

I thank the Secretary of State for accepting many of the amendments to the Bill proposed by our colleagues and others and thank his colleague in the House of Lords for accommodating not only Liberal Democrat and Cross-Bench peers, but Labour peers who have joined us in bringing forward such amendments. Will he give an undertaking to continue to work collaboratively to improve the Bill to the very end and reject Labour’s allegations that it did not force privatisation on the NHS, which we are definitely not doing?

I am grateful to my right hon. Friend and thank him for his positive remarks about my noble Friend Earl Howe. I attach to that my appreciation to Baroness Northover for the work she has been doing in another place and to the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, who has been heavily engaged in discussing some of the amendments. I recall that nearly a year ago there was a clear expression of interest from the Liberal Democrats, as a party, on how they felt the Bill should be improved. I was pleased that we were able to bring forward changes that reflected virtually all those. Indeed, they are reflected directly in what my right hon. Friend the Deputy Prime Minister said in his letter yesterday.

If the competition in the Bill is just an extension of what the previous Government did by introducing independent sector treatment centres and everything else, why are more than 90 clauses writing into the law of the land that competition policy should run the NHS, not the NHS, as has been the case in the past?

I would not characterise this as an extension of the independent sector treatment centres programme. That is precisely what we do not need to do with the private sector. Under the Labour Government, the private sector was paid 11% more than the NHS, which was wrong, and in another place there is a legislative provision that will prevent discrimination in favour of the private sector. The Bill will carry forward exactly the principles and rules of co-operation and competition, as reflected in the panel set up under the previous Government. As NHS Future Forum set out, the reason for having that in the Bill, with Monitor exercising those responsibilities, is so that there will be a health sector regulator, rather than that being done without health expertise by the Office of Fair Trading.

Some Conservative Members never criticised, and in fact supported, the previous Government when they introduced private health care providers into the NHS. In his letter, the Deputy Prime Minister said that the use of private health care firms has been explicitly prevented as a result of his involvement. Is that really true? If so, should someone not tell him who is running this Government?

My hon. Friend knows perfectly well that we are a coalition Government and, therefore, this is a coalition Bill that reflects the views of the whole coalition. To that extent, I reiterate to her and to the House that, as the Deputy Prime Minister has quite rightly said, the legislation will not allow discrimination in favour of the private sector in the way that the Labour party did.

All those royal colleges, all those nurses and all those doctors know that this Bill is about privatisation. Along come these tin-pot Liberals, who put forward an idea to make a few marginal shifts. It is the biggest con trick of all time. This is about trying to save the face of those people, who should have opposed the Bill from the very beginning. Drop this lousy Bill.

I will tell the hon. Gentleman exactly what the Bill is about: improving care for patients. That is what I care about, and it ought to be what he cares about. [Interruption.]

Order. May I say to the hon. Member for Colne Valley (Jason McCartney) who is chuntering inanely from a sedentary position, to no obvious benefit or purpose, that the Chair is perfectly capable of adjudicating upon what is and is not in order and that it does not behove an hon. Member to seek to intervene in such matters? These proceedings have thus far been entirely orderly. That is the beginning and the end of the matter.

There is an old political saying that the Liberal Democrats say one thing at one end of their constituency and another thing at the other end. Will the Secretary of State lay that rumour absolutely to rest—that they are not saying one thing at this end of Parliament and another thing at the other end?

I am happy to be able to tell my hon. Friend that I, with my colleagues, have had very constructive engagement with my Liberal Democrat colleagues in government and, indeed, during the course of our debates in another place.

Following the question from the hon. Member for Mid Bedfordshire (Nadine Dorries), can the Secretary of State tell us when he was aware of the letter, whether he was consulted on it and whether he had any input?

I believe that I answered that question. The point of the letter was to reflect the discussions that we have been having.

Does my right hon. Friend accept that the debate so far risks ignoring the importance of the Bill’s renewed outcomes? In cancer, for example, such focus is instrumental in driving forward earlier diagnosis, which in itself could save quite literally thousands of lives.

My hon. Friend is absolutely right, and I am sure that in that context he shares with me the appreciation of the benefit that will come from campaigns to promote the early awareness of cancer, such as, following piloting, the roll-out of the national campaign for the awareness of bowel cancer symptoms.

Is not this another attempted PR and political fix for a mismanaged health Bill that is again in chaos? Which of the changes set out in the Deputy Prime Minister’s letter was not agreed in government first?

Would that be the same Bill that the right hon. Gentleman described as “consistent, coherent and comprehensive”?

May I ask the Secretary of State today to confirm again that when the Bill becomes law the national health service will remain funded through taxation and free at the point of use regardless of ability to pay? Opposition Front Benchers should stop scaring our constituents with grossly inappropriate scare stories.

My hon. Friend is absolutely right, and I share his deep resentment at the way in which Opposition Members misrepresent and distort what is in the legislation and then, when people write to us concerned about what is in the legislation, accuse us of not listening to them. Opposition Members should read what is in the Bill, find out that it achieves the purposes that my hon. Friend describes and not distort it.

Order. I simply say to the Secretary of State that to refer to somebody “distorting” something is perfectly in order, but I know that he would not want to use an unparliamentary term and talk about anything being “misrepresented”. I think he is accusing a Member of being erroneous. I think that is what he has in mind.

There is clearly no mandate, either in this House or in the other place, for these huge changes and massive top-down reorganisation. Some 162,000 people have signed an e-petition calling on the Government to drop the Bill, so may I remind the Secretary of State that his own party’s election manifesto stated that

“any petition that secures 100,000 signatures will be eligible for formal debate”?

Does he not think that it is time for us to have a full debate about the issue, to find out who is in favour and who is against and to drop the Bill?

The hon. Gentleman, himself, was present at 40 sittings in Committee, during which his hon. Friend the Member for Halton (Derek Twigg), the shadow spokesman, said that the Bill had been thoroughly scrutinised. We have debated it; in another place they continue to debate it very fully and very constructively; and I believe that that will deliver us the right Bill for the NHS.

Will my right hon. Friend confirm that this Bill is superb news for patients, and that under the Secretary of State’s new Bill, my constituent who requires less invasive hip treatment in a neighbouring county will be able to choose to go to that other provider for a less expensive operation that will do him less harm and more good?

Yes, indeed. For the first time, not just through the legislation but through the modernisation of the national health service, patients will be able to see, through the data, the quality of the service provided in the NHS by a range of providers. When patients are asked whether they want—on that basis, as NHS patients with a free service based on their need—to be able to choose who should provide them with care, 81% say that they want that choice. We will give them that choice; Labour would not.

The Deputy Prime Minister’s letter promised

“additional safeguards to the private income cap”.

Will the Secretary of State explain what are these additional safeguards aimed at ensuring that foundation trusts cannot focus on private profits before patients?

We have already made it very clear in another place that the legislation will ensure that foundation trusts should have the freedom to increase their private income, not least in relation to international work. However, their principal legal purpose is for the benefit of NHS patients, and so they already have to make sure that they reflect that in their annual reports and in their annual plans. As the letter indicates, we are, with my hon. Friends in another place, working on a further corporate governance mechanism to ensure that foundation trusts reflect their principal legal purpose in all that they do. [Interruption.]

Order. I want to hear the questions and the answers. Members are a little overexcited and they need to calm down just a tad. A good example of such calm will now, I am sure, be provided by Mr John Hemming.

Under Labour, local democratic accountability in the NHS was reduced by the abolition, without consultation, of the community health councils. The letter refers to the creation of the health and wellbeing boards, which will increase local democratic accountability for the health service. Will the Secretary of State explain how that will ensure that local services in the health service better fit local health needs?

That is a very powerful and positive step forward. Through the joint strategic needs assessment and the strategy derived from that, local authorities and the NHS will now increasingly work together to deliver integrated services extending across health, social care and public health.

Will the Secretary of State please confirm whether all the changes outlined in the Deputy Prime Minister’s letter now represent Government policy?

The Deputy Prime Minister’s letter accurately reflects the discussions that we have been having in another place—[Interruption] I do not see why that is funny; it is very simple—in anticipation of the amendments that will be debated there on Report.

The previous Labour Government, of whom the shadow Secretary of State for Health was an active member, negotiated private finance initiative contracts that are costing the NHS almost £3,000 per minute. Will the Secretary of State detail what his Department and the Treasury are doing to help to alleviate this enormous level of debt, which has risked the viability of some NHS services?

We are helping all trusts with PFI contracts to manage the costs of those contracts. Seven trusts were left with unsustainable PFI contracts, and we have made it clear that we are willing to help support them. Labour Members—they are not even listening—are distorting the nature of this legislation, which does not permit privatisation. Given that during their time in office they left the NHS with 102 hospital projects owned, in effect, by the private sector, with a PFI debt of £67 billion, it is outrageous for them to sit there pointing fingers at us.

If this is such a marvellous measure that protects the NHS, as the Secretary of State has been saying, why is it opposed by virtually all those in the medical profession and by most of the public, to the extent that he has become almost a hate figure? Is it because he lacks persuasiveness or because this is a worthless Bill that will undermine the NHS?

The hon. Gentleman should go and talk to the clinical commissioning groups across the country that are delivering on the clinical leadership that will modernise and improve the NHS rather than simply sitting reading the newspapers and imagining that he knows what is going on in the NHS.

Does my right hon. Friend agree that when she was in government, Baroness Williams was one of the chief architects of ruining the state education system in this country? Given that, why would a Conservative-dominated Government wish to dance to her tune?

My right hon. and noble Friend Baroness Williams is now a member of the Liberal Democrat party, and in that respect I am not aware that she has ever transgressed in government.

Last year, when the Bill was in its infancy, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), gave me an assurance that NHS services in Trafford undergoing changes would not be privatised. In the light of all the amendments, is the Secretary of State able to offer me the same assurance, especially given that the Co-operation and Competition Panel in his Department has instructed the local NHS to devise a contract that is divided into six separate lots, with a warning that competition must be prosecuted, otherwise there will be severe consequences?

Will my right hon. Friend confirm that the previous Government were, in 2006, given the advice that it was neither possible nor desirable to ensure that competition was not allowed in the NHS because it is subject to EU competition rules?

I am glad that my hon. Friend has made that important point. People such as the former Chair of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), who is no longer in his place, are fond of asking why we are introducing competition into the NHS. We are not. The Bill does not introduce competition to or extend competition within the NHS. The legal advice disclosed in one of today’s national newspapers makes it clear that the previous Labour Government introduced the reach of competition law into the NHS by introducing the elective choice programme in 2006.

If the Health Secretary believes so much in the value of his Bill, why did he not take the time to explain it to voters before the general election, instead of promising that there would be no top-down reorganisation of the NHS?

I refer the hon. Lady to pages 46 and 47 of the Conservative party manifesto and, to understand the Bill fully, to the Liberal Democrat manifesto.

I encourage my right hon. Friend to read the minutes of the Hinckley and Bosworth health and wellbeing partnership meeting. He will see that clinical commissioning groups are in place and that there is a priority on early intervention. There is support for the health and wellbeing board and its priorities. Does that not go completely against what we are hearing from Opposition Members?

I had the pleasure—before Christmas, I think—of meeting the local authority, the director of public health and the three clinical commissioning groups from across Leicestershire, who are all enthusiastic about the opportunities presented by the modernisation of the NHS legislation.

Is it not clear to even this Secretary of State that the Bill is now a dog’s breakfast? Given that doctors, nurses, the public, the Lords and many Government Members oppose the Bill, what mandate does he have for such a radical change of the NHS?

I refer the hon. Gentleman to the point I made about the mandate. Beyond the mandate, staff across the NHS have been clear for years that they want more clinical leadership and clinically led commissioning; they want local authorities to integrate health and social care services more effectively; and they support the transfer of leadership in health improvement into the hands of local authorities. The Bill achieves those principles. That is why all through last year, the Royal College of Nursing told me that it supported the Bill.

The Secretary of State is not the only one who has noticed a shift in the Opposition’s stance on independent sector provision. I have started to receive letters from constituents who are concerned that Labour will next call for much-loved NHS services that are currently provided by the independent and charitable sectors to be shut down. Will he assure me that if those calls are made, he will fight them?

My hon. Friend makes an important point about what would happen if we followed the apparent views of the Labour party. More than 11% of mental health services in this country are provided by the private and charitable sectors. Recently, I was in Northampton, where St Andrew’s Healthcare provides important services. I opened its new building, which will provide first-rate, state-of-the-art care for mental health patients. The attitude of the Labour party is that all that should be shut down.

Up and down the country, thousands of NHS staff have already been laid off—so much for no top-down reorganisation—and many of them are being re-employed at vast expense. When will the Secretary of State publish the costs to date, before the Bill is even law, of this overarching reorganisation?

I do not know whether the hon. Lady has read the latest monthly data on the NHS work force, but since the election the number of non-clinical staff has gone down by 15,000, including the number of managers by 5,800, and the number of clinical staff has risen, including more than 4,500 more doctors.

Order. I would like to accommodate a few more questions, but from now on I really do require single-sentence questions without preamble and comparably pithy replies.

My constituency has considerable health inequalities, so I very much welcome the fact that tackling health inequalities is at the heart of the Bill. Does the Secretary of State share my surprise that the Opposition do not similarly welcome that?

Will the Secretary of State now accept that, contrary to the impression he is trying to create, the opposition to his muddled bill is not some plot by health workers or trade unions with vested interests, but is coming from many Liberal Democrats, the majority of the British public and almost the entire health community, to whom his Government promised to listen?

Opposition Members distort what is in the Bill and tell their constituents that it is something other than what it is, and then they come to the House and say, “Oh, it’s muddled.” It is not muddled at all; it is they who are muddled.

I do not know any GPs who want to see inappropriate use of the private sector. They will be doing the commissioning and the public will be able to see what they are doing. Should we not let them get on with it?

My hon. Friend is absolutely right. I was very pleased to hear what was said by Dr Sam Barwell—I think her name is Barwell.

Barrell. One had only to listen to how Dr Sam Barrell and her colleagues in the Baywide clinical commissioning group in my hon. Friend’s constituency are providing clinical leadership in south Devon and Torbay to be absolutely clear that the Bill is right to give them that responsibility and that they will use it extremely well.

If the Deputy Prime Minister’s letter agreed with the Secretary of State, as the Secretary of State has confirmed today, can he explain why the Minister of State, Department of Health, the right hon. Member for Chelmsford, said on Radio 4 yesterday that there would be no further changes to the Government’s Bill?

My right hon. Friend and I are very clear that, as I explained—really quite carefully, I thought—it is customary in another place for some of the issues that have been debated to be reflected in amendments on Report, and that is what will happen.

Can the Secretary of State confirm that the principles underpinning the Bill are that the NHS is and will remain free for all patients; that a person’s GP knows them and their needs best; and that although we are spending billions of pounds more than Labour would have done, every pound needs to work as hard as possible if the NHS is to be modern and provide care for the future?

My hon. Friend is right, not least on his point that the coalition Government are investing in the NHS, with real-terms increases each year. That contrasts with the Labour Government in Wales, who in the course of this Parliament intend to reduce spending on the NHS by more than 6% in real terms.

At a very lively Conservative away-day last Friday, a document was issued that stated:

“If we changed or altered the bill now, we would end up in a no man’s land, and chaos.”

Four days later, can the Secretary of State confirm the Government’s position?

The Government’s position is that there has been very constructive debate in Committee in the Lords, and I look forward to that being reflected in equally constructive debates on Report.

Liberal Democrats hate Labour’s health reforms, which result in hospitals being paid for operations whether they happen or not. Does the Secretary of State consider that the NHS, for which he remains responsible, would be in better health had Labour’s reforms been subjected to the parliamentary scrutiny that his have?

My hon. Friend makes an extremely good point. Many of the issues that have been the subject of some of the most heated debate on the Bill have been raised because Labour never addressed them. He is absolutely right that one result will be that in future, it will no longer be possible for £250 million to be paid to the private sector for operations that never take place.

Can the Secretary of State explain why he is prepared to get into further discussions with the Liberal Democrats to help them to save seats in May, but not to do so with doctors, nurses and midwives, who all oppose the Bill? Is he engaged in patching up the coalition rather than in providing proper health care?

I think I made that perfectly clear not only in the course of the initial consultation on the White Paper, but then through the NHS Future Forum. Many thousands of NHS staff contributed their views to the NHS Future Forum, which made many recommendations and we accepted them all.

Is it not the case that the text of the letter merely reflects the Government’s amendments on Lords Report? The Opposition really should have done their homework, because it has been on the website since 1 February. They are four weeks out of date.

My hon. Friend is right up to a point. On Report in the other House, amendments reflecting the debate in Committee will be tabled. They might not all be Government amendments, but I am looking forward to constructive amendments. As I have said, if amendments from Liberal Democrat or indeed Labour peers are constructive and will help to improve the Bill, we will accept them.

Will the Secretary of State clarify whether the changes are significant, as stated by the Deputy Prime Minister, or merely reassurance, as stated by the Prime Minister’s official spokesperson?

Will my right hon. Friend assure my constituents that our NHS reforms will outlaw the practice common under the previous Government of the private sector being paid more than the NHS for exactly the same operation?

Yes, that is absolutely correct. For the first time, we will have a provision in law that prevents the kind of discrimination in favour of the private sector that was practised in government by the Labour party.

In an article in The Guardian on 13 February, Baroness Williams said:

“The way out of this mess is not hard to find… What that would mean for the bill would be dropping the chapter on competition”.

Will the Secretary of State clarify whether he is willing to accept such an amendment from Baroness Williams?

As I understand it, I have come to the House to answer questions about a letter, jointly signed by the Deputy Prime Minister and Baroness Shirley Williams, which does not say that.

In 2007, when he was Secretary of State, the shadow Secretary of State waxed eloquent, saying that he celebrated the private sector in the NHS. Has my right hon. Friend any clue to what changed the right hon. Gentleman’s mind?

The Secretary of State said this afternoon that competition will not be allowed to get in the way of sensible integration of services, so why is Trafford Healthcare proceeding with the commissioning of provider services in six penny packets, as described by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins)? How can that support the sensible integration of services?

The hon. Lady must be aware that under the Bill, we will move from primary care trusts that, under current public procurement rules, are very often not capable of integrating services as they would want, to clinical commissioning groups, which will have the freedom and power to do so.

Will my right hon. Friend confirm that clauses 22 and 25 of the Bill remain, which for the first time ever put a duty on the Government to deal with health inequality.

I am grateful to my hon. Friend. That is indeed true, and it gives the lie, if you will forgive me, Mr Speaker, not to anybody in the House, but to those who would represent the legislation as having the effect of widening health inequalities. Health inequalities widened under the Labour Government. For the first time, our legislation will place on all NHS bodies and the Secretary of State a duty to tackle and reduce health inequalities.

The Secretary of State will know that Tower Hamlets clinical commissioning group in my constituency has decided today to ask the Government to drop the Bill, citing the bureaucracy it will generate as a key reason. When the structures he has established to advise him tell him that they want no part in the nightmare that he is creating, is it not time to think again and drop the Bill?

I have been to Sam Everington’s practice in Bromley-by-Bow, which has been gearing itself up. It will use the powers in the Bill and will do so very effectively.

Foundation trusts will be given the freedom to increase private services and patients will have the right to choose any provider that meets NHS standards. Was the Secretary of State as surprised as I was to learn that that was in the Labour party’s 2010 manifesto?

I am grateful to my hon. Friend. I suppose that we should not be surprised that the Labour party in opposition has abandoned everything it said in government, but for it to abandon so quickly so many of the things it said even in its manifesto is pretty dramatic.

If I may say so, I think that the Secretary of State and the Government have been at sixes and sevens over this issue in recent weeks and they would be better off dropping this disastrous Bill. However, may I press the right hon. Gentleman on the answer he gave to my hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty)? If he now agrees that the amendments are significant, as the Deputy Prime Minister has boasted, does that mean that the Prime Minister’s spokesperson was wrong to downplay them as a mere reassurance?

I am clear that sometimes we need to ensure through amendments that we not only achieve the effect that we intend, but reinforce it in legislation. Some of them will reassure, and some will have significant effects directly on the governance of the NHS.

To avoid the continuation of the erroneous—that is the word, I think—statements from the Opposition, will my right hon. Friend confirm that the GP survey continually referred to was filled in and returned by about 6% of GPs only, and therefore is not reflective of the views of GPs across the country, such as those at HealthEast, who are keen to get on with commissioning quality health care for their patients?

Yes, I have the benefit, as do many of my colleagues on the Government Benches, of talking to GPs across the country, individually and in clinical commissioning groups. The issue to address is not the distortion of legislation and its effects but realising benefits for patients. That is where we are. We want to achieve and improve quality for patients. That is where GPs are, where nurses are and where doctors and health professionals are. The legislation is part of the broader process of devolving responsibility to them and patients to allow that to happen.

What is the Secretary of State most worried about: the frightening chaos of the billion pound commissioning underpinning the reforms that will benefit Circle health care, United Health, PricewaterhouseCoopers, KPMG, McKinsey and the rest at the expense of patients; or the personal embarrassment that he would feel if he did what he should do—if he listened to the professionals and the thousands of people who have signed the e-petition—and dropped the Bill?

I will tell the hon. Lady what most frightens me: it is that if we had carried on the inheritance from Labour, with waste and bureaucracy escalating and a year-on-year reduction in productivity in the NHS, in a financially challenged environment the quality of patient care would have suffered. At the moment, we have an NHS that is doing magnificently well at raising performance across the service while transforming itself to meet future challenges.

This feels like groundhog day—nothing ever seems to change. Every time the Labour party brings this issue to the House, we hear the same statements, questions and scaremongering. Does the Secretary of State agree that we hear nothing new from the Labour party? All we hear is the same scaremongering—nothing new, no new thinking.

I bring good news to my hon. Friend. Out there in the real world, things are changing: there are clinicians, doctors and nurses across the country who are taking the opportunity of this responsibility to improve services for patients; there are patients who realise that they will get additional voice and choice; and there are local authorities that realise that, through their health and wellbeing boards, they can use this to drive improvements in health for their population. Those are the things that are changing. Unfortunately, not only is the Labour party not changing but it is going backwards.

I listened carefully to the Secretary of State’s answer to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), but it struck me as gobbledegook. Will he spell out in plain English the additional safeguards to the private income cap that the Deputy Prime Minister is seeking to ensure that foundation trusts cannot focus on private profit before patients?

Will my right hon. Friend detail for the House how the Bill will help to improve patient safety and quality of care, which are so important to my constituents and those of everybody in the House?

I am grateful to my hon. Friend, because there are a number of ways in which I think this issue will be important. First, for the first time, how we improve patient safety will be published in a consistent way, as one of the five domains of the outcomes framework. Secondly, that will be demonstrated by achievement—for example, we have the lowest ever levels of methicillin-resistant Staphylococcus aureus and clostridium difficile infection. Thirdly, the NHS Commissioning Board, which will be established under the legislation, will take national responsibility for the delivery of patient safety, linking it directly to commissioning, whereas in the past the National Patient Safety Agency was an organisation on its own and was not directly linked to the exercise of commissioning responsibility.

In Chester, we are seeing the effects of tens of thousands of patients fleeing the NHS in Wales to seek better treatment in England. Will my right hon. Friend reassure my constituents that there is nothing in the Bill that will cause the English NHS to be as bad as what we see over the border in north Wales?

Not only are the Labour Government in Wales cutting the budget of the NHS, where we are increasing it, but the situation is as my hon. Friend describes, with 91.6% of patients in England being seen and treated within 18 weeks, whereas in Wales the comparable figure is just 68%.

This urgent question has been very much a repeat of last Wednesday’s lengthy debate. Does my right hon. Friend agree that the last 50 or so minutes has been more about spiteful politics than about policy and patient care?

I agree with my hon. Friend, but fortunately this urgent question has given me another opportunity to remind everybody in this House and beyond that this Government’s purpose is to empower patients, get front-line doctors and nurses in charge in the NHS, cut our tiers of bureaucracy and improve the quality of care for patients.

I thank colleagues for their succinctness, which enabled 53 Back Benchers to question the Secretary of State in 42 minutes of exclusively Back-Bench time. I am indebted to the House.

Under the terms of Standing Order No. 24, I now call Mr William Cash to make an application for leave to propose a debate on a specific and important matter. As I am sure the hon. Gentleman will know, he has three minutes in which to make such an application.