George on the NHS Bill

• [Mar 16] Andrew George (St Ives, Liberal Democrat): It is a pleasure to follow Angela Smith, who made a number of important points about the extent of the reorganisation, quoting Chris Ham of the King's Fund. Indeed, a number of other authoritative sources point out that these reforms amount to the most significant reorganisation of the NHS since its inception 62 years ago. Therefore, we need to look with great care at the issues that arise as a result of this substantial change. We are talking about the public institution that the majority of people in this country hold most dear, so we have a great responsibility in this House to deal with these issues seriously.

I query the hon. Lady's final point on the purpose of today's debate. If the intention was to alienate those who broadly share her and the shadow Secretary of State's analysis of the Bill, then adopting the device of today's debate was probably the best way of doing so, so I congratulate them on that. Following the debate in our conference in Saturday, I would say that if Labour Members have a significant interest in the future of the NHS, the most appropriate thing to do would be to try to form a coalition of the people who share concerns about the Bill. Many of the institutions that she and others quoted-the King's Fund, the BMA, the GMC, the royal colleges and many others-share concerns on the basis of a very objective and dispassionate point of view and could make a significant contribution. That is how we should be doing it, not by using-I am sorry to describe it thus-the playground politics of an Opposition day debate as a means of advancing the issue.

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Angela Smith (Penistone and Stocksbridge, Labour): Is the hon. Gentleman indicating that he would be prepared to talk to Labour Front Benchers on meaningful ways of taking this debate forward?

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Andrew George : I am prepared to talk to anyone who wants to engage constructively in improving the Bill to ensure that it achieves its stated intentions, because I do not think that it will, given the nature of the reorganisation proposed in it. The reason I will not be joining the hon. Lady and her colleagues in the Lobby to support the motion is that it is tactically wrong at this stage to engage in such antics. This issue is a great deal too important to be turned into a party political playground game.

I am pleased that the Secretary of State said today that he is prepared to listen and engage. We need to explore every opportunity to engage in constructive dialogue with him, involving all the stakeholders I mentioned, and, indeed, those in the Labour party who want so to engage, to find a way through and to ensure that the genuine concerns about the impact of the Bill are properly scrutinised. Yes, they are being scrutinised in the Bill Committee, but before we get to Report stage in this House, it is important that we create a coalition of the bodies that share these concerns. Rather than inviting them to go out on to Parliament square and wave their placards and so on, it would make a lot of sense to encourage them to engage in greater constructive dialogue than we have succeeded in achieving so far.

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Stephen Dorrell (Charnwood, Conservative): Does my hon. Friend agree that the case he is making is reinforced by the fact that our right hon. Friend the Secretary of State has already moved two amendments to the Bill dealing with the cherry-picking issue and-this was mentioned by the Prime Minister today-price competition. The amendments have been tabled to ensure that the Bill addresses concerns expressed by the hon. Gentleman and some of his hon. Friends.

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Andrew George : I am grateful to my right hon. Friend. Indeed, that is a very encouraging indication of the fact that the Secretary of State is prepared to listen. As far as I am concerned, however, he is not prepared to go far enough in reassuring me on those points, because taking the word "maximum" out of the clauses relating to price competition and the role of Monitor, the market regulator, is still insufficient. We have not got time to debate that today.

There are several issues, through which I shall canter in the few moments I have left, about the Bill's objectives and what we want to achieve. First, we want to drive patient choice and innovation. I do not think that anyone would disagree with that, but we do not need to demolish the core-or at least the institutional architecture-of the NHS and PCTs, and alienate the majority of clinicians against achieving such innovation and patient choice.

Again, I think we all agree that giving power to communities and patients is highly desirable. However, although GPs will be given responsibility for commissioning services through the consortia, I do not think that they are particularly asking for that. Having spoken to many of them and listened to the national debate, I believe that they are reluctant, or at best resigned to taking on those roles, feeling that they have to follow that course.

If we want decentralisation, why will we end up with the ludicrous centralisation of commissioning NHS dentistry and dispensing? Indeed, every contract for a GP surgery will be centrally commissioned from an NHS commissioning board in Leeds. That is absurd. It does not even achieve what it is claimed that the Bill wants-decentralisation.

Many attempts have been made to argue that the Bill will cut bureaucracy and managers. I am not sure that that will happen. A big focus of today's debate is the impact of competition, which will be unleashed. Once the private sector has its foot in the door, the genie will be out of the bottle. It is clear that everything, including designated services, in my view, will be open to contest. Although it is claimed that the Bill will result in fewer managers, I think that it is a dream come true for litigators, lawyers and management consultants.

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John Pugh : Will my hon. Friend give way?

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Andrew George : I am afraid that I do not have time.

The idea that the Bill will drive integration and social care is more wishful thinking because there will be less coterminosity between commissioning boards and local authorities under the Government's proposals for an increased number of commissioning bodies than we have now.

Much rethinking needs to be done, and I hope that Government Front Benchers are listening.

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