I beg to move,
That this House
believes there is an important role for the private sector in supporting the delivery of NHS care;
welcomes the contribution made by private providers to the delivery of the historic 18-week maximum wait for NHS patients;
recognises a need, however, for agreed limits on private sector involvement in the NHS;
notes with concern the Government’s plans to open up the NHS as a regulated market, increasing private sector involvement in both commissioning and provision of NHS services;
urges the Government to revisit its plans, learning from the recent problems with PIP implants and the private cosmetic surgery industry;
believes its plan for a 49 per cent. private income cap for Foundation Trusts, in the context of the hospitals as autonomous business units and a ‘no bail-outs’
culture, signals a fundamental departure from established practice in NHS hospitals;
fears that the Government’s plans will lead to longer waiting times, will increase health inequalities and risk putting profits before patients;
is concerned that this House has not been given an opportunity to consider such a significant policy change;
and calls on the Government to revise significantly downwards its proposed cap on the level of private income that can be generated by NHS hospitals.
It is a year this week since the Health and Social Care Bill was introduced in this House. Unlike the Government, we wanted to mark the anniversary, and having this Opposition debate seemed the right way to do it. It is happening because the Government have effectively sidelined this elected House from the debate about the future of the national health service. No single issue matters more to the people who put us all here, but what the future holds for the hospitals in our constituencies is no longer up to us. Instead, it is the unelected House that is right now carving up England’s NHS through back-room coalition deals. Ministers are making a series of desperate concessions in the other place to try to preserve the pitiful levels of support that remain for this unwanted and unnecessary Bill.
For the avoidance of doubt, let me summarise this scandalous situation. Here we have a Bill that nobody voted for. It was not in either the Tory or the Lib Dem manifestos, and it was ruled out specifically by the coalition agreement, yet it was rammed through this elected House so that the real decisions could be taken down the corridor in the unelected House. It is truly an affront to democracy that our nation’s most valued institution should be treated in this way. It thus falls to the Opposition to let this House take a view this evening on the far-reaching amendments to the Bill that are now being tabled, which Ministers were clearly too scared to table in this House.
No, I would not agree. I shall explain the policy that our Government adopted on the private sector and how different it was from that of the Government whom the right hon. Gentleman supports. In making our argument we will expose the terrifying gap between the Prime Minister’s rhetoric on the NHS and what he is doing in reality. People will recall the efforts that went into rebranding the nasty party. The Conservatives were at great pains to tell us that they would be pro-environment, a bit less tough on crime and pro-NHS going forward. Many photo calls were arranged to send those messages to the public, but it was poor old NHS staff who featured far more than huskies or hoodies in being brought in to promote hastily made political promises. We were told there would be real-terms increases for the NHS, a moratorium on accident and emergency department closures, thousands more midwives and, famously, no top-down reorganisation—four promises made in opposition: four promises broken in government. I still have not worked out how a Prime Minister can go from agreeing there should be no top-down reorganisation with his coalition partners after the election to bringing forward just weeks later the biggest top-down reorganisation ever in the history of the NHS. How does that work? Perhaps Lib Dem Members will enlighten us this evening.
Our evasive Prime Minister is the master of making statements that sound good at the time only to turn out to be meaningless in practice. Tonight we will focus on his most outrageous yet. On
“That’s why, when I think about what our NHS will look like in five years time, I don’t picture some space-age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation”.
Those were his words—“no privatisation”.
The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.
The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on
“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”
He followed that up on
“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”
Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.
Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.
Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.
Does the right hon. Gentleman accept that the cap was not clearly defined but was very variable according to the hospital, and will he now say that it was wrong for the previous Government to set the cap at over 30% for the Royal Marsden hospital, which is a centre of excellence?
I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.
Just to be clear, could the right hon. Gentleman explain why it is in the interests of NHS patients in a particular hospital for that hospital’s capacity to generate additional revenue from the private sector to be limited by a cap?
I will explain that very clearly. I am sure the right hon. Gentleman will have read the impact assessment to the Bill, which warns of the risk of lengthening NHS waiting lists if existing capacity is made available to private patients. It says that if additional capacity is provided, there might be no effect on NHS waiting lists. That is why this is dangerous, because all the progress that Labour made on reducing long NHS waits would be put at risk by the careless and cavalier policy of simply abandoning the principle of the cap, which has stood us in good stead.
That is not what I said. I understand that the preferred policy was to have no caps or limits, but even if a generous and liberal cap were introduced there would be a major risk that hospitals under financial pressure would give beds, theatre time and appointments to private patients, enabling them to jump the queue and giving a much worse deal to NHS patients. That is the risk that the cap was designed to mitigate and that is why we support it.
There is a simple explanation. The right hon. Gentleman will remember, as I do, the debate around the foundation trust legislation. There were worries that if hospitals were made more independent and were not directly managed by the Department they would put the treatment of private patients before that of NHS patients. The cap was introduced to mitigate that risk. He will know that we had a policy that all trusts should become foundation trusts in time—a policy that his Government have adopted—so that the cap would apply to all NHS hospitals in time. I think that answers his question.
If that is the case, rather than that it was forced on the Labour party by a rebellion of Back-Bench MPs in 2002, why did the right hon. Gentleman’s election manifesto in 2010 say that Labour would remove the cap?
It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.
Does my right hon. Friend know whether the private operations will be charged at tariff? Is there a limit on the charge hospitals can make? Will it be at tariff or at a premium on tariff? Would that not be a way of increasing the amount of resources coming in? Less work would be done on the NHS.
My hon. Friend raises an important issue. We have not had those safeguards; there has been no explanation from the Government of any safeguards that will be introduced under this liberal measure. This evening, we need to probe exactly what they have in mind. During the pause, they said that they would restrict any competition on price in the NHS, yet they are bringing forward a measure that would allow NHS facilities to be used for the treatment of private patients with no guarantee that the private sector would not try to undercut NHS tariffs. Those are precisely the questions that the Government have to answer.
Does my right hon. Friend agree that the fundamental change in the Bill is that the Government are imposing a new form, Monitor, which directly applies competition regulation in NHS delivery of services and undermines the principles and rules for co-operation and competition—PRCC—that arbitrate between commercial services and the NHS, which controlled the market?
That is exactly the point. The proposal has to be seen in the context of the health system the coalition Government want to create. They want a broken-down system where one hospital is pitted against another, where there is a duty on the Secretary of State to promote the autonomy of NHS organisations, so that they are out there on their own, having to stand or fall on their merits, with a clear incentive to drive up income gained through a relaxed private patient income cap. I shall come to that point in a moment.
Ministers are shouting, “Choice”, but is my right hon. Friend prepared to reflect on the merits of the private sector, both in the UK and abroad, in the efficiency of the service that it delivers?
When the Bill was introduced, great claims were made that it would improve NHS efficiency. That was one of the reasons the Government gave for subjecting the NHS to a huge top-down reorganisation; they wanted to make the system more efficient, but they made a mistake that many people make over time. They claimed that the NHS is inherently inefficient when in fact international evidence shows the exact opposite: the NHS model is the most efficient health care system in the world. That is because control of the system is democratically accountable, and national standards can be set through bodies such as the National Institute for Health and Clinical Excellence and entitlements can be set at national level. If that control is removed, we will see the emergence of a much less efficient health care system, like the many market-based systems.
“notes with concern the Government’s plans…increasing private sector involvement in…commissioning and provision of NHS services.”
In Dover, our hospital was run down over the 13 years until 2010 and is now a shell. Why should the GPs not be able to commission another provider if the foundation trust will not fulfil its long-standing pledge to build a hospital and provide proper services for my constituents?
My argument would be that if those decisions are to be made, the people who make them should be accountable to the hon. Gentleman and the House, whereas the Bill that his right hon. Friend the Secretary of State is introducing proposes to push those things away. There will be an independent commissioning board that GPs and clinical commissioning groups will not be able to overturn; it will make the decisions. That is a completely unacceptable state of affairs.
Before the last election, we proposed a modest loosening of the private patient cap in response to pressure in another place when we were debating the Health Act 2009, but compared with our modest reforms, the Government’s plans are off the scale. Instead of private sector activity at the margins, the Health and Social Care Bill places market forces at the heart of the system. The private sector will not support the NHS, but will replace large chunks of the service in commissioning and provision.
I should be interested to learn—as I am sure would the whole House—the right hon. Gentleman’s definition of modest loosening. In the four years between 2006 and 2010, the amount of money going to the private sector rose from £2 billion to about £12.2 billion. Does the right hon. Gentleman simply oppose the 49% cap or will he pledge to reverse it if he returns to government? What exactly would the cap be? Would it be 30% or 12%? Please let us know.
May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.
I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to Chris Skidmore that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.
Could the shadow Secretary of State kindly answer the questions put by my right hon. and hon. Friends about what modest means? [ Interruption. ] If I might read it out, the 2010 Labour manifesto says:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”
There was no mention of a modest increase; it was open-ended.
The Minister is not listening. I answered his question. I proposed a small increase in the cap—in single figures; a couple of per cent, as I am on record saying at the time, to give NHS hospitals more freedom to generate more income, to be put back into improving standards for NHS patients. Can the Minister honestly look me in the eye and tell me that 49% is not a world away from the NHS that he inherited from our Government?
That is absolutely the point. The Government want to create an NHS where Ministers can no longer say what can or cannot be done, so we have GP practices, such as Haxby in York, sending letters to their patients saying, “We have decided that we are not going to fund your minor operations any more, but by the way, we are now providing those operations. Here’s our price list.” That is absolutely disgraceful, but it is a glimpse of the NHS that will emerge if the Health and Social Care Bill goes through. My hon. Friend is absolutely right: we must consider the wider context, within a system with competition at its heart and where every hospital is on its own and they are fighting each other. That is the context in which this 49% proposal needs to be considered. It represents a break with 63 years of NHS history and a “genie out of the bottle” moment. That is why we ask the House to reject it.
My right hon. Friend is making a strong point. The Minister says that the cap was flexible during our term, but that was under principles and rules for co-operation and competition rulings. That meant that the servicing out of the contract was based on care quality. Unfortunately, the Bill does not have any area dealing with quality of care; it is purely about price. It is about allowing Monitor to apply the pure regulatory format of the Competition Commission as it exists in other utility markets.
My hon. Friend anticipates me. I shall come to precisely that point in a moment, and it will backs up his point that the Bill is akin to the privatisations of the 1980s.
Just hang on and listen. Nothing has been done to the Bill to bring together the Prime Minister’s and Deputy Prime Minister’s promises that there would be no privatisation. There has been no substantial change since the pause.
Let me come directly to whether the Bill represents a privatisation of the kind that we saw in the 1980s. In doing so, I shall refer to a report from the King’s Fund, which I recommend to the hon. Lady. The Government have failed to introduce measures that they promised, months after the pause, so it is still considered appropriate for a body as respected as the King’s Fund to make a fairly shocking comparison that, indeed, the Bill is similar to the privatisations of the Thatcher Government. The report says:
“The Government’s proposals draw heavily on the regulatory framework developed in telecoms and utilities regulators …Interestingly, Secretary of State for Health Andrew Lansley’s own ideas for the reform of the NHS, developed while in opposition, were born out of his experience of the privatisation and regulation of utilities in the mid-1980s when he was Principal Private Secretary to Norman Tebbit.”
There we—[Interruption.] Okay, there we have it. That is the view of the King’s Fund—this is a privatisation along the lines of those we saw in the 1980s.
To back up that point, the King’s Fund quotes from a speech that the Secretary of State gave in 2005 to the NHS Confederation. He said this of the 1980s privatisations:
“The combination of the introduction of competition with a strong independent regulator delivered immense consumer value and economic benefits.”
There are two problems with that statement. First, there are real questions about whether gas, electricity, water and rail customers feel that they have had immense value. Secondly, it is troubling that the Secretary of State for Health, of all people, considers the delivery of health care directly comparable to telecoms and utilities.
This is getting a little tedious. May I refer the hon. Gentleman to the motion, which indeed does the very same thing? It recognises the fact that there is
“an important role for the private sector” in the delivery of good NHS care and celebrates the role that it played in helping us to deliver the lowest ever NHS waiting times. Before intervening in future debates, he might like to read the motion that the House is considering.
“maximise competition, transfer risk to the private sector…appoint a strong, pro-competitive regulator…set out clearly the standards which have to be met and how operators will be held accountable for them…be clear about how and by whom universal service obligations are to be met…ensure high quality information for customers” and have
“more customers rather than fewer.”
That is, do not have a few monopolistic health authority purchasers. The Secretary of State is nodding in assent that that is, essentially, his Health and Social Care Bill. This is, of course, the basic framework that the House of Lords is considering, despite the Deputy Prime Minister’s claim to have rejected
“the free market dogma that can fragment the NHS.”
A phrase leaps out of that 2005 speech, which, in the light of recent events, needs to be challenged. It is
“transfer risk to the private sector”.
While acceptable in theory, I wonder whether recent experience with the private cosmetic surgery industry has led the Secretary of State to reconsider whether and how, in the health context, that can be delivered in practice. In an NHS based on commercial contracts, would there not always be arguments about legal liability when things went wrong? Would it not be much harder to control quality and costs in such a way, rather than through the current planned and managed NHS system that we have?
The point that I am making is about how to manage the system, how to ensure proper regulation and how to ensure that NHS providers and the system work in the interests of NHS patients. If the right hon. Gentleman is arguing that there would be the same control managing the system through a series of fragmented commercial contracts, I would be interested to have that debate with him. Frankly, I do not believe that he is being serious, if that is his point.
I have been contacted by constituents who access their cancer and cardiac care from Barts and from the London hospital. They fear that as a result of the Bill their health needs will be deprioritised in favour of private patients who can afford to pay. What would my right hon. Friend say to my constituents about their fears?
I wish I could allay the fears of those people, but when there is a proposal placed at the heart of the NHS for hospitals to devote half their facilities—their beds, their appointments—to private patients, how is it possible to give that guarantee to those patients, particularly when the Government are relaxing the waiting time standards that we did so much to establish in the NHS, with the two-week wait for cancer referrals and 18 weeks for elective operations, and a four-hour wait in A and E? How can we have that confidence when, effectively, the Government are taking those safeguards off the public and giving the green light for a massive expansion of private sector treatment in NHS hospitals?
Does my right hon. Friend have any answer to the question whether private providers with obligations to their shareholders will inevitably face a conflict if risk is offloaded to them when their responsibility to their shareholders is naturally to ensure the best possible financial outcome for them?
My hon. Friend is absolutely right: this proposal brings that conflict right to the heart of the NHS. At the moment, NHS hospitals have a paramount and overriding duty to the treatment of NHS patients, but considering a health care system whereby services would be delivered through a series of commercial contracts brings that conflict of interest into the health care system—shareholders on the one hand, patients on the other. That is why there is such deep disquiet among health professions about these proposals. It is why those professions applied so much pressure last year, and the pause was ordered. It is why, I am afraid, they are still unhappy today—the Government have not addressed their concerns.
Before the right hon. Gentleman continues with this wholly erroneous line of discussion, will he reflect on the fact that the Bill introduces, for the first time, a transparency in accounting between NHS activity and any private income in any foundation trust, which he did not put into legislation? The Bill introduces a transparency that there can be no cross-subsidisation between NHS resources and any private activity. It introduces a legal requirement for any foundation trust to explain to the public at its annual meeting how it has used any private income to the benefit of NHS patients. Will he reflect on the fact that the primary purpose of a foundation trust is to provide NHS services? For it to do anything that was to the detriment of NHS patients, involving private patients, would be contrary to its primary purpose and unlawful.
There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.
I thank the right hon. Gentleman for giving way; he is very generous. Does he not agree that the two hospitals with the highest patient cap—the Royal Marsden and the Royal Brompton—use the money that they make through private income very effectively, and put it back in to make them centres of excellence for all patients, particularly their NHS patients?
That was the policy of the previous Government, but the cap was clearly defined. It was a tight cap, and it reflected historical levels of work. What we are talking about is a liberalising measure to enable the private sector to double if not quadruple the amount of work that it is doing, which is why we are debating the motion.
I shall pose a question for the Health Secretary, who mentioned safeguards. If it is all fine to create a different NHS in which we have many more private contracts, might not the NHS risk register have something to say about the risks of creating such an NHS and the additional challenges of delivering health care through a system based on commercial contracts? Might it not lead to a diversion of spending on lawyers and consultants, away from patient care? Is not there not a great irony, as we have heard the Health Secretary bemoan a lack of ability to intervene in the recent situation while, at the same time, here he is promoting a Bill that removes his ability to do so on a much wider basis? He wants to hand over his ability to intervene to the independent NHS Commissioning Board. The irony of his position will not be lost on many people listening to the debate.
I have attended this debate to try to ascertain the direction of travel of Labour policy and to try to gain an understanding of its philosophy and underlying principles. I am somewhat confused, because you seem to be all over the place. Do you believe that health care is a commodity—[ Interruption. ] I apologise; I meant the right hon. Gentleman. Do you believe that health care is a commodity or not? Do you believe that access to health care is a right or not? The answers to those questions underpin the policies that you will introduce, I presume, in the next couple of years.
I do not know whether those questions were for me or for you, Mr Deputy Speaker, but let us assume that they were for me.
I introduced the NHS constitution, which enshrined for the first time the basic rights of NHS patients. I am proud to have done so, so I do not need any lectures from the hon. Gentleman about what we should do to improve health care in this country. I said in the motion that I am prepared to go back to my policy before the election in which we said that we would consider loosening the private patient cap. That is the policy that I have introduced to the House tonight. I am not prepared, however, to stand here to accept the wholesale abolition of that control to create a situation in which NHS hospitals can devote half their beds to private patients. If he is happy with that in his constituency, let him make the argument for it, but I am making an argument for a very different NHS from the one envisaged by Ministers.
Is not the real question for the Government why on earth they have written the Competition Act 1998 into the Bill? Why have they written the Enterprise Act 2002 into it, and why have they allowed European competition law to create the haemorrhaging of a socially provided service under category B legislation? Why have they done that? What is the point? It can only be to loosen enterprise within the NHS for competitive purposes so that the private sector can come in.
My hon. Friend makes an important point. If the Bill was really about clinical commissioning, as the Government said at the beginning, and putting GPs in control, that could have been done through existing NHS structures. They could simply put clinical teams in charge of existing PCT structures. It could be done without any hassle or cost, but no, they completely broke down and rethought the whole system, because it was an ideological reform. Doctors oppose the measure, because they saw through the Bill, and saw it for what it was: a privatisation plan for the NHS.
Let me give three examples that demonstrate why the Prime Minister has not lived up to his “no privatisation” claim. The first is a letter sent by the Department on
“The NHS is facing a period of significant transition and financial challenge. But this is not a reason to delay action to address patient demands for greater choice”.
It went on to require all PCT clusters and clinical commissioning groups to identify three community services by
The second example is the Department's guidance document to CCGs entitled “Developing commissioning support: towards service excellence”. I shall quote from the beginning of the document, which gives a clear statement of intent:
“The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”
It could not be clearer, which is why members of the British Medical Association council called the document a “smoking gun”, confirming their fears of a stealth privatisation. The document confirmed that the Government envisaged large-scale privatisation of services to support commissioning—jobs that are currently carried out by public servants. It puts into practice the comments made by Lord Howe on
“The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care. If you can do that then you can do well. But you know that won’t be easy, the NHS isn’t a place to earn a fast buck...they will not give up their patients easily”.
On commissioning, he said:
“Commissioning support is an absolutely critical area for CCGs. Some of it will come from the PCT staff who will migrate over to the groups but there will need to be all sorts of support at various levels…There will be big opportunities for the private sector here.”
With reference to that second example, I ask the Secretary of State how on earth is that policy consistent with the promise made by the Prime Minister and the Deputy Prime Minister of no privatisation?
That brings me to the third example, which we have discussed tonight. Just before the Christmas recess, the plan, which threatens to change the very character of our hospitals, was sneaked into the House of Lords. I do not seek to argue that that provision would change the NHS overnight, but in the context of a competitive NHS, where there is an obligation to promote the autonomy of hospitals, I believe that it would completely change the character of our hospitals and the way they think and function over time. The effect of a cap at this scale—a staggering 49%—means that hospitals could give equal priority to private patients. It sets up the NHS and private sector up in direct comparison with each other, and creates the conditions for an explosion of private work in NHS hospitals.
It is such a liberal provision that the Government’s amendment will have virtually the same impact as abolishing the cap completely, and it is a world away from the current situation. It fails to protect the interests of NHS patients by giving equal priority to other patients. Indeed, it creates a conflict of interest, as trusts could even seek to push patients into their private beds.
I thank the right hon. Gentleman for giving way; he been extraordinarily generous in accepting interventions. When he discusses privatisation of services, does that include services taken on by charities, social enterprises and mutuals?
I am not against services being taken on by charities, voluntary providers and, indeed, the private sector. I have never set my face completely against that, but I see clear limits on the involvement and the role of the private sector in the delivery of NHS services. I see the private sector supporting the NHS, working at the margins, providing innovation and support.
The Health Secretary sees the private sector replacing large chunks of the NHS, set up in direct competition with it, which is a very different policy. I ask the hon. Gentleman whether he was elected to the House to support such a policy. Do not the constituents of Dover quite like the NHS that we have, and want it to continue as it has for its first 63 years?
I want briefly to mention the impact assessment. It gives this specific warning if hospitals loosen the private patient cap without creating additional capacity:
“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients. This is the eventuality that the PPI cap was originally introduced to prevent.”
In other words, there would be a return to that traditional Tory choice in health care—wait longer or pay to go private.
That sums up the big difference between this Government’s approach to the private sector and that of the previous Government. In our system, the private sector was encouraged to throw its lot in with the delivery of the best possible NHS standards of care to NHS patients. By contrast, the world view of this Government sees private health care as a way out of the public NHS, trading on its failures as a means of boosting the private market.
The next question that I ask the right hon. Gentleman to answer is whether the 49% plan can possibly be consistent with the Prime Minister’s promise of no privatisation. We make a reasonable request this evening. We do not reject out of hand any change to the existing PPI cap on foundation trusts. Voting for the motion does not imply opposition to the entire Health and Social Care Bill. But we do reject a 49% cap, which is tantamount to abolition, and we call on the Government to revise it significantly downwards. Voting for the motion will send a signal from the House that the Government need to rethink.
In conclusion, I give notice that we will continue to oppose the Bill outright, and we will put everything we have got into that fight. Let me be clear. The Prime Minister should withdraw his “no privatisation” promise or he should withdraw his Bill. He cannot have it both ways. If the Bill is passed, I do not think there is any question but that it will lead to the privatisation of large chunks of commissioning and NHS provision. The truth is that this is an illegitimate Bill. Nobody voted for it, and it is a Bill that the Health Secretary has mis-sold to the public and professions. He claimed that it was about putting doctors in the lead, but doctors can see it now for what it is. From here on in, we on the Opposition Benches will call it what it is—a privatisation plan for the national health service.
We have called the debate tonight to bring these dangers home to a much wider audience. Time is running out for the NHS and I will give everything I have got to protect the NHS that I believe in. This is worth fighting for because the NHS stands for something different in a world where large parts of our national life have been taken over by profit and money. Recent events have shown the dangers of mixing medicine with the market. People see health as different from other areas and overwhelmingly support the NHS as it is. By and large they trust it and see it as one area of national life where the money motive has not taken over. They want it to stay that way and they look at social care as a warning, showing how a fragmented system can drag standards down. Nye Bevan said there would be an NHS for
“as long as there are folk left with the faith to fight for it”.
This is the moment of greatest threat to our health service and I tell the Health Secretary and the Government straight tonight to drop this illegitimate Bill or face the fight of their lives. I appeal to Members in all parts of the House who have worries about where the Government are going with the Bill to send a direct message to the Government and to vote as their constituents would want them to do—for an NHS that will always put patient care before profits. I commend the motion to the House.
We start 2012, and what is the Labour party’s priority? Is it to welcome the NHS improvements in performance, as reported before Christmas—that waiting times are low and stable, that there are now 90% fewer breaches of mixed-sex accommodation standards than at the same time last year, that hospital infections are at their lowest ever levels, or that there are more doctors and fewer managers in the NHS than at the election? No, none of those was Labour’s priority. Was it to welcome the increase next year announced just before Christmas in NHS funding for primary care trusts, or since Christmas an increase in the funding available this year direct to clinical commissioning groups to enable them to meet the needs of their patients? No, it was not that.
I know that the Secretary of State was at Salford Royal hospital last week, where the abundance that he is describing does not seem to be around. That hospital—he went there to talk about nursing—will have to lose many hundreds of its nurses. It seems strange to us that we do not seem to see the abundance that he talks about and it certainly was not apparent at Salford Royal.
That is exactly the same question that the hon. Lady asked during oral questions. The Prime Minister and I did indeed go to Salford Royal hospital and we were tremendously impressed by what is being done there but, like other hospitals across the NHS, as part of a process of using resources more effectively and as part of the consequences of a transfer to supporting patients more in the community than in the acute sector, that hospital is changing the way it manages its services, and it is delivering cost improvements. We make no bones about that.
We delivered £4.3 billion of cost improvement in the NHS in the last financial year. We are aiming to do more this year. We delivered £2.5 billion, according to the deputy chief executive of the NHS, in the first two quarters. Every penny saved by reducing costs in the NHS is available to be reinvested in the NHS. That is why we are in a position to improve the performance. The hon. Lady did not talk about how that funding is becoming available through savings on central costs—for example, £150 million extra funding this year announced since Christmas for support for the integration of health and social care.
Was that Labour’s priority? No. Did Labour come to the House and say, “We want to welcome the way the NHS has achieved an increase in the flu vaccine uptake,” or the simple fact that flu activity at this stage is at its lowest level for the past 20 years? No, none of that. The hon. Lady talked about Salford Royal and the way nurses are engaging in some best practice—
No. I am still answering the previous intervention. Nurses are engaging in best practice to improve the quality of care for patients in Salford Royal. Was that the basis upon which Andy Burnham chose to come to the House to talk about the things that matter to patients—the quality of care being delivered to patients? No, it was none of those things.
No. I answered the hon. Lady’s question.
Labour Members came to the House not to pursue the priorities of patients or of those who work in the NHS, but to pursue Labour’s priorities. They are not in 2012; they are not even in the 21st century. They are back in the past. Talking of the past and somebody who lives in the past, let us listen to Grahame M. Morris.
Let me explain to the hon. Gentleman. The average time that patients waited for in-patient elective procedures in the NHS according to the latest data was 8.4 weeks, which is exactly the same as at the time of the last general election. For out-patients it was 3.9 weeks, compared to 4.3 weeks at the election. For diagnostic tests, despite the fact that the NHS has performed 440,000 more diagnostic tests, the average waiting time is 1.8 weeks, the same as at the election. Long waits? The hon. Gentleman did not say that according to the latest data published the number of patients waiting more than a year for their treatment went down 40%, compared to what we inherited from the Government at the time of the last election.
The motion is all about Labour’s going back to the past. I am staggered. It is almost like revisiting Barbara Castle’s antipathy towards the private sector, or that of Frank Dobson, the only former Labour Secretary of State now, even including himself, that the right hon. Member for Leigh seems to agree with.
I will ask the House to reject the motion, but in a way I am asking the House to reject those sentiments all over again, because we have been here before with this debate. Far from the House not having had an opportunity to consider issues including the private income cap, I remember having exactly this debate on Report. We were very clear about that. We discussed it when the White Paper was published, we discussed it when the Bill was debated on Second Reading, when it was in Committee and on Report, and it has been debated again in another place. I hope to use this opportunity to trample on some of the myths that the right hon. Member for Leigh and his Friends are propagating about the Bill.
If the right hon. Lady has any such evidence, she should give it to me. Let me explain that at the moment any individual member of NHS staff would be acting contrary to the NHS staff code of conduct if they saw a conflict between private sector and NHS activity and gave priority to private patients to the detriment of NHS patients. Technically speaking, under the legislation we inherited it is not explicitly unlawful for a foundation trust to do that but, as I explained to the right hon. Member for Leigh, a whole series of specific safeguards relating to the relationship between private and NHS activities was introduced to the Bill in another place. It makes it clear that the principal purpose of a foundation trust is to benefit NHS patients and NHS services. To do anything that is to the detriment of NHS patients will be unlawful. There are specific safeguards stating that foundation trusts cannot cross-subsidise between NHS activities and services and private services. If the right hon. Lady has information of a particular instance, she might as well give it to me.
I am grateful to the Secretary of State for giving way again. Does he not understand that a person who has this information is terrified of putting it into the public domain—[ Interruption. ] I am sorry, but he is wrong. We are talking about someone’s job and livelihood. I simply asked him whether this is correct or not. Does he know?
I have no knowledge of what the right hon. Lady describes. Let me remind her that those working in the NHS have a responsibility to disclose anything that that they think is to the detriment of their patients’ interests, and under legislation on public interest disclosure they have protection. I announced just before Christmas that in the latest contract for an enhanced advice line there should be a whistleblower advice line.
I note what the Secretary of State says about staff who have concerns being encouraged to express them, but in the case of Trafford Healthcare NHS Trust, where a private company has just been commissioned to provide orthopaedic pain relief services, the staff had absolutely no knowledge that that commissioning was going on. How can he be sure that staff will be able to raise concerns when there is such a lack of transparency?
What the hon. Lady describes is precisely what has happened time and again under the legislation we inherited, which is not transparent. Primary care trusts were not accountable or transparent and an enormous amount of activity on tenders went on with tenders that involved the private sector and was not conducted in the way that we want, which is on the basis of a tariff and on the basis of which provider is best able to deliver the highest quality.
Let me deal with the first of the myths propagated by the right hon. Member for Leigh: that we have some kind of privatisation agenda. We do not. As I recollect, the only time any Government had a specific objective to increase the role of the private sector in the NHS was when he was a Minister, his hon. Friend Liz Kendall was a special adviser to the Department for Health and Patricia Hewitt was Secretary of State. That was when they were going out and saying they wanted to increase the role of the private sector to 10% or 15%, and the Health and Social Care Bill contains specific provision not to allow such discrimination in favour of private providers in future.
The Secretary of State says that he has no proposals to increase privatisation. Will he confirm that he has sent a letter through the Department asking clinical commissioning groups to identify three community services that will be subject to a compulsory competitive tender?
It is not. The right hon. Gentleman, having been Secretary of State, ought to understand the difference between compulsory competitive tendering and any qualified provider. Under compulsory competitive tendering, it is the primary care trust that gets to choose who provides the service, but under any qualified provider it is patients who get to choose. One example is access to wheelchair services. Voluntary sector organisations, such as Whizz-Kidz, are setting out to provide a better service. From its point of view, that is not competitive tendering. Wherever Whizz-Kidz provides the service, patients in that area—[ Interruption. ] If he wants to have a conversation with other Members, he may by all means do so, but I will sit down.
I answered the right hon. Gentleman’s point and I am afraid that it proceeds from a fundamental misunderstanding of the difference between competitive tendering processes, which have been the stuff of primary care trusts—in the past it was they that decided who should provide services—and giving patients access to choice so that they can drive quality. Unlike competitive tendering, which was generally price-based tendering decided on cost and volume, under any qualified provider it is not about price, but about quality.
My right hon. Friend mentioned the provision of wheelchair services, which is a matter we have been looking at in Kent when considering how commissioning can be taken forward. Whizz-Kidz offers really great and radical ideas. Is it not the case that the Labour party would have condemned disabled people to the same standard-issue NHS wheelchairs rather than allowing them real choice across the spectrum?
My hon. Friend is absolutely right. That is precisely why on that basis, using the any qualified provider approach, the chief executive of the NHS can set out the ambition that a child who needs a wheelchair should get it in a day. In the past they would have to wait and then would not necessarily get the wheelchair they wanted, or in any reasonable time scale. This is about driving improvement and quality. Many NHS providers will respond positively to that and deliver the quality, but if they do not we ought to be in a position to believe that what really matters in the NHS is the quality of the service provided to patients. That used to be what the Labour party believed in, which I suppose was why its last manifesto, written when the right hon. Gentleman was Secretary of State, stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
That is a complete description of what we are setting out to do. It is a description of the any qualified provider policy and something that he has now completely abandoned, and he has abandoned patients in the process. It is absurd.
The objective of the Bill and of the Government is simple: continuously to improve care for patients and the health and well-being of people in this country, and that includes improving the health of the poorest fastest, and to ensure that everyone, regardless of who or where they are, enjoys health outcomes that are as good as the very best in the world. That is what we are setting out to do.
The motion states that the private sector already plays an important role in providing that care. Indeed, once upon a time the Labour party was in favour of it. The right hon. Gentleman said in May 2007:
“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”
Like my hon. Friends, I do not understand where he is coming from. The motion tries to face both ways, stating that Labour agrees with the private sector but also wants to have less of it. It agrees that the private sector can make a valuable contribution, but wants to stop it doing so. What matters to patients is the quality of care they receive, the experience of their care and the dignity and respect with which they are treated. Whether the hospital or community provider is operated by the NHS, a charity, a private company or a social enterprise is not the issue from the patient’s point of view. From our point of view, we should not make that the issue. The reason it will not matter is that, whoever is the provider of care, the values of the NHS—universal health care, paid for through general taxation, free and based on need, not ability to pay—will remain unchanged. No NHS patient pays for their care today; no patient will pay for their care in future under this Government. On that basis, I can absolutely restate what the Prime Minister said: under this Government and on our watch the NHS will not be privatised.
With all due respect to the Secretary of State, I am afraid he cannot say that. We heard the excellent example of Whizz-Kidz, which is a fantastic organisation, but he cannot guarantee that it will get the contract, because Monitor, as we all know from the Bill, has primary control over who gets the service, and it will apply competition law, purely and simply. There is absolutely no guarantee that the third sector or co-operatives will get in, and in any case there is no guarantee that care quality will be applied in the decision.
Forgive me, Mr Deputy Speaker, but I hardly know where to start, given the degree of ignorance associated with that point. Monitor does not decide who gets the service; patients and commissioners do, and the clinical commissioning groups determine how they commission the services. Quality is absolutely at the heart of the Bill, and at the heart of how we structure the statutory duties of all organisations concerned, but the hon. Gentleman goes on about the application of competition law. Actually, there is no extension of competition law in the NHS and no extension of EU competition law as a consequence of the Bill; it simply enables the NHS to have a health-specific regulator so that the application of competition law and EU competition rules, in so far as they apply because the Bill does not change their application at all, is carried out by a health sector regulator.
Myth No. 2 is that the impact of a wider range of providers in the NHS will drive down the quality of care, but we will give patients more choice and more control over their health care. If people are given clear information about the quality of different providers, they will, with their doctors and nurses helping as their commissioners, choose the provider that is best for them, and the Health and Social Care Bill means that all providers will compete on the quality of their services, not on the prices that they charge.
There will be no incentive for doctors to encourage their patients to opt for the cheapest option, because there will be no cheapest option; there will only be the best-quality option.
No, it is nothing to do with Monitor in those circumstances; those whom I have mentioned will make the choice.
The more choice there is, the more innovation there is, the more new ideas there are and the more pressure there is on all providers from all sectors constantly to raise their game for patients. The evidence supports that.
I have been listening to the right hon. Gentleman very carefully, and he made a statement a moment ago about there being no privatisation—that privatisation will not result from the Bill. Is he saying to us that his Health and Social Care Bill will lead to no additional privatisation of commissioning or provision in the national health service? It is a very clear question.
There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[ Interruption. ] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.
The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.
Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.
The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?
We did, and I have celebrated it already, because it delivered the lowest-ever NHS waiting lists, which I celebrate again. But I am listening to the right hon. Gentleman, and I get the impression that he is completely confused. He cannot admit that his Bill will lead to more privatisation, but that is at its core, and people listening to this debate would have more respect for him if he came to the Dispatch Box and made an argument for what he is trying to do—to create a market in health care. Is it not the case that he is just floundering around? He is no longer able to say what the Bill is really about. It is about more privatisation, so why does he not try to make an argument for what he is trying to do, instead of avoiding the issue?
When the right hon. Gentleman finds that his argument is not working, he resorts to abuse. It is very simple: the Bill is not about privatisation. Patients will have access to NHS-funded services; the commissioners of those services will be NHS commissioners who are accountable to the NHS through statutory bodies, and they will not be able to transfer that responsibility to the private sector. Provision will be determined by the choices that patients and their doctors and nurses make about who is the best-qualified provider, and that choice will be made on quality, not on any other basis.
On the simple fact that we are looking to use competition within a tariff system, studies from Imperial college and the university of Bristol have recently shown that when it is introduced quality increases. Indeed, research from the university of York’s centre for health economics suggests that, if anything, the use of such competition has tended to support a reduction in the inequalities of access and care, rather than to lead to greater inequalities.
Let me provide some examples, bearing in mind the path that the Labour party is looking to go down. The Eastbourne Wound Healing Centre, a social enterprise set up by a nurse and an occupational therapist, specialises in wound healing. Patients who go to their clinic often have wounds that have not healed over three years, but more than eight out of every 10 of them have those wounds healed in just six weeks. Should we prevent patients being seen there because it is not actually owned by the NHS?
The City Health Care Partnership in Hull provides palliative care at home for patients and does not put profit before patients. One carer said that
“this clinic is so different, the focus is about how the illness is affecting you and what can be done to support you through it.”
Should we stop it doing that?
Another example is Inclusion Healthcare, a social enterprise in Leicester, which the hon. Member for Leicester West might know. It provides specialist health care to the homeless. Jane Gray, its director of nursing and development, stated:
“We’re providing a better service than we did in the NHS. We’re able to innovate and shape our services without constraint.”
Should we shut it down? Would that reduce inequalities? No, it would make them worse.
I endorse entirely the Secretary of State’s criticism of the previous Government’s bias towards the private sector. I would be grateful if he clarified an issue in respect of the integration of health services. Does he agree that, particularly at the secondary and tertiary level, the question is not so much about privatisation, because if the NHS was to lose its preferred provider status, the gradual loss of many aspects of secondary and tertiary services in, for example, an acute general hospital might undermine the viability of the hospital?
The position is very clear, as the hon. Gentleman should know from the debates that we have had. Continuity of access to services through the NHS is one of the central responsibilities of commissioners and of Monitor. If there is any threat to the continuity of those services, they can step in and take measures to ensure that the services continue, including by agreeing funding beyond the tariff to make that happen. If the extension of “any qualified provider” could lead directly to the loss of access to essential services for patients, the commissioners and Monitor do not have to go down that path. They can make those judgments.
I caution Andrew George about hanging his hat on the NHS as preferred provider. Before the last election, the right hon. Member for Leigh said that the NHS should be the preferred provider. His philosophy said that the NHS should be allowed to get it wrong twice before the private sector gets a look in. From the patient’s point of view it is, of course, a very cheerful thought that they will be surrendered to the policy of NHS as preferred provider.
Curiously, in March 2010, before the election and at the same time as he said that his policy was the NHS as preferred provider, the right hon. Gentleman published the “Principles and rules for cooperation and competition”, which he seems to be very fond of and which we are maintaining. That document stated:
“Commissioners must commission services from providers who are best placed to deliver the needs of their patients.”
It also stated:
“Commissioners and providers must not take any actions which restrict choice against patients’ and taxpayers’ interests.”
The reason that the right hon. Gentleman published that document was that he knew that the policy of NHS as preferred provider was already going to be the subject of a legal challenge and that it would not survive that challenge. That is why he restated exactly the principles of co-operation and competition that we intend to incorporate directly and without amendment into the way in which Monitor does its job.
No, I am going to move on. There has to be time for people to contribute to the debate, so I do not want to go on for too long.
The Health and Social Care Bill will, for the first time, ensure that private and voluntary sector organisations have to meet the same exacting standards and be regulated in exactly the same way as NHS organisations when they provide NHS services. Because that extends to any organisation providing NHS services, whether it be private or voluntary, it is disingenuous at best and possibly disreputable for the right hon. Member for Leigh to draw any comparison with the PIP breast implants scandal. There is no comparison between the position of a private company working in the private sector providing private services and the role of a private company operating inside the NHS under NHS controls. He knows that there is no comparison. In the NHS, the patient will be wholly protected. It is our intention to ensure for the first time—this did not happen under the Labour Government—that when a private sector provider operates in the NHS, it has to provide equivalent indemnities to its patients as would be provided through the NHS. That did not happen when the independent sector treatment centres and other things were brought in. There will be better protection. The private sector operating outside the NHS is a different matter.
Myth No. 3 is that raising the cap on private income will lead to a worse deal for patients. The paradigm example is the Royal Marsden NHS Foundation Trust.
Its private patient cap is set at 31%. That is because in 2002, 31% of its income was derived from private sources and that was the basis on which it became a foundation trust in 2004. Its current private patient income is 25.8% of its total income. The fact that it has a cap does not mean that it goes up to it. In fact, its private patient level has come down slightly. The effect of setting the cap at 10%, as suggested by the right hon. Member for Leigh, would be to take about a fifth out of the income of the Royal Marsden. The Royal Marsden, like Great Ormond Street, is a classic example of how having a thriving private income from research, joint ventures and patients coming from overseas can get a hospital to a place where it can also consistently be recorded as one of the most excellent hospitals in the NHS, where NHS patients get the best care. It has on one hand the highest level of private patient activity—or, strictly speaking, private income—and on the other hand the highest standard of NHS care. The two things are entirely compatible.
May I just ask the Secretary of State to correct what he has said about the statements that I made? I did not say that I would reduce the Marsden’s cap. I said that we would allow a small increase on the existing cap that is linked to trusts’ own historical levels of private work. It would help the debate if he would be careful to get my position right. I was not talking about an across-the-board, blanket 10% cap, I simply said that some trusts with a much tighter cap of 1% or 2% were asking for a little extra leeway, which I said should be provided. I am not proposing a 10% cap across the board.
I think I could be forgiven for not understanding what on earth the right hon. Gentleman was talking about, since he did not put it in his motion and my colleagues had to ask him three or four times before they got anything close to an answer—he was saying “10%, or in single figures, we’re not quite sure what it would be”.
We have always been clear that there is an inherent unfairness in some foundation trusts having a cap set at the maximum 31% and others having it set at 1.5%, as all mental health trusts did when they were allowed to become foundation trusts. Technically, all NHS trusts have no cap at all, and some of them use that flexibility. Great Ormond Street, for example, is an NHS trust, not a foundation trust, and it uses that freedom, mainly to treat patients from overseas. Are we to stop that happening? I ask the right hon. Gentleman where he would set the cap for Great Ormond Street. I will give way to him if he will tell me.
I am not defending the existing policy. The cap was set for each trust individually to reflect historical levels. The reason why trusts such as the Marsden and Great Ormond Street have a more generous cap is the large amounts of private work that they carry out. [Interruption.] Yes, but if and when they become foundation trusts under the Secretary of State’s policy, they will have caps reflecting their historical levels of work if he adopts my suggestion. I have proposed that each individual cap be modestly loosened, but he proposes an across-the-board 49% cap applying to all NHS hospitals, effectively meaning that every NHS hospital could devote half their beds to the treatment of private patients. Will he confirm that that is the effect of the policy that he is bringing forward?
Answer came there none. The truth is, we are doing exactly what the right hon. Gentleman and his party intended to do. At the election, Labour said in its manifesto:
“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS”.
That is what we are doing.
We are giving foundation trusts freedom to generate revenue from other sources that can be invested directly into the NHS. When Moorfields, for example, sets up a clinic in the middle east in a joint venture, should we say, “No, you’re not allowed to do that, because it might imperil your ability to support NHS patients”? Actually, it will help their ability to do so, with NHS Global encouraging the NHS.
I believe in the NHS and in the ability of NHS hospitals and providers, which in the past have had their horizons limited, to move beyond those horizons and deliver much better care. That can include turning them into international providers of choice in joint ventures across the world, and even joint ventures in this country, whether in research or the provision of additional services. However, as I explained to the right hon. Member for Leigh in an intervention, under the Health and Social Care Bill the principal purpose of any foundation trust will be the provision of NHS services. Doing anything that would be to the detriment of its provision of NHS services would be unlawful. Foundation trusts cannot cross-subsidise from NHS services into private services.
Individual staff in the NHS have a duty not to allow their private activity to be to the detriment of their NHS activity. Foundation trusts will have an obligation to be transparent in accounting for the two sources of income, and they will have an obligation to report at their general meeting how they have used their private income to benefit their NHS patients.
I am afraid that what the right hon. Member for Leigh says is a tissue of nonsense. The 49% amendment was introduced only to make it abundantly clear that if the principal purpose of a foundation trust is the provision of NHS services, by extension that would not be consistent with the balance of its activity being private rather than NHS activity—hence 49%. There is no specific intention that NHS foundation trusts should increase their private income to any specific degree.
My hon. Friend is absolutely right. The Labour party appears to be going backwards. Its 2010 manifesto said:
“We will support an active role for the independent sector working alongside the NHS in the provision of care”,
but tonight’s motion says that Labour has abandoned that policy. I quoted earlier the Labour party’s commitment to giving patients the choice of the best available provider. Its policy tonight is to abandon patients, including the 81% who told a survey that they want to exercise choice. Labour’s manifesto said it would give foundation trusts freedom to expand and increase their private services. It has now abandoned that policy.
Why does Labour do that? Why did it abandon those policies? Perhaps it is because the Labour party is a wholly owned subsidiary of the trade unions. Labour is interested not in patients or the NHS, but in the trade unions, because its policy is all about the protection of trade union interests—vested interests. The guarding of the vested interests is the remaining activity of the Labour party, but it will diminish over time.
Let me tell the shadow Health Secretary very simply what we are setting out to do. Under this Government, the power to choose will increasingly lie in the hands of patients, doctors and nurses, and incentives will encourage all providers to integrate their care and improve the quality of their care. The result is not a fragmentation of the NHS or inequalities, but better, higher-quality care, and integrated NHS care that offers everyone the very best care available. We will use choice—patients’, doctors’ and nurses’ interests in delivering that choice—and the best quality provision to deliver better outcomes for patients. That is why I urge the House to reject the Opposition motion.
Order. We have very limited time and I wish to get quite a lot of Back Benchers in, so I am going to start with a six-minute limit. I may have to reduce it, but I am going to try to ensure that we get everybody in.
To respond to some of the misrepresentations of the Opposition, I worked for the NHS for some 12 years and hold it in the very highest regard. I am here to defend the NHS against privatisation, and I make no apology for doing so to Government Members or anyone else for that matter.
It is fitting to pay tribute to all those who work in the NHS and who make it such a tremendous institution. I also pay tribute to members of the British Medical Association consultants committee who took part in Bevan’s run to mark their opposition to the dreadful Health and Social Care Bill as part of the “Drop the Bill” campaign. They ran 160 miles in six days from Nye Bevan’s statue in Cardiff to deliver a postcard to the Department of Health in Whitehall to call on the Secretary of State to drop the Bill.
In the limited time available, I should like to address the point in the motion about the cap and to address Government Members’ misrepresentations. The private patient income cap, which was set up under the previous Labour Government in the Health and Social Care (Community Health and Standards) Act 2003, which established NHS foundation trusts, was a protection against the need for profit overtaking the needs of NHS patients. With all hospital trusts set to become foundation trusts by 2014, a meaningful cap on the amount of resources that can be directed to the care and treatment of private patients becomes even more important.
The passage of the Health and Social Care Bill—it is in the Lords at the moment—can only be described as a shambles. It is an incredibly unpopular piece of legislation. There could have been agreement on, for example, clinical involvement in commissioning, but that could be achieved without this incredible disruption to the service. I certainly believe that it is harmful to the future existence of the NHS. There is no mandate or basis for it in the Conservative or Lib Dem manifestos or in the coalition agreement. This NHS privatisation plan might be better described as an NHS privatisation paving Bill—
With all due respect, I have very limited time and I am not going to take any interventions.
Any utterance about the nature of the NHS reforms planned by the Secretary of State during the general election campaign was heavily disguised. He weaved a tangled web in private health care during his seven years as Opposition spokesman on health. A few moments ago, he mentioned Labour’s involvement with the trade unions, but it is the involvement of the Conservatives with private health care interests that should be the subject of scrutiny.
NHS professionals, staff, the public and experts alike have all rejected the ethos of profits over patients, but the Secretary of State will not be deterred. He has defended his move by claiming that foundation trusts have a core legal duty to care for NHS patients. However, at the same time he is telling these trusts that they must make a profit to survive, and that if they run a deficit, they risk failure. That could mean being taken over by another trust or, as we have seen in the case of Hinchingbrooke hospital in Huntingdon, being taken over by a private sector provider.
We have not seen the Bill’s risk assessment, but as a member of the Public Bill Committee, I saw the impact assessment, and in point B95 it confirms that rather than improving services at hospital level through performance management, poor providers
“may need to contract or exit completely.”
That has created the ultimate Catch-22 for foundation trusts, with a conflict between patients and profits. A further Government proposal to scrap the provision in the 2006 Act which allows failing foundation trusts to return to NHS control puts further pressure on the need for trusts to pursue profits and has been opposed by the NHS chief executive, Sir David Nicholson.
I urge hon. Members to vote for the motion to ensure that patient care is placed before private profit and to send a clear and strong message to the Government that they must think again about their plans to ratchet up privatisation in our beloved NHS. The Minister of State, Department of Health, Mr Burns has often quoted Nye Bevan, but to quote Robin Cook,
“If he believes that the spirit of Nye Bevan supports his changes to the NHS then there is a wheel missing from his ouija board.”
It is a pleasure to follow Grahame M. Morris. He and I are both members of the Health Committee and, surprisingly perhaps, we more often find ourselves in agreement about the objectives that we are trying to deliver than is obvious from the nature of the debates across the Floor of the House.
I shall focus my remarks on the speech by the shadow Health Secretary. I have some quite good news for him—he was a far better Secretary of State than he himself appears now to believe. As Secretary of State, he did not allow himself to fall victim to the kind of prejudices that have been ventilated this evening. Tonight, he fell into the old trap of eliding two concepts and pretending that they are the same. The two concepts are, on the one hand, privatising the health service, and on the other, involving the private sector in the improvement of care available to patients. As Secretary of State, he was well able to distinguish between those two concepts and pursued policies of involving the private and voluntary sector when there were opportunities to improve care for patients. He now prefers to forget the fact that during his time as a Minister we not only heard plans for involving the private sector in improving the care delivered to patients but saw an open-minded attempt to bring in the private sector to improve the process of commissioning in the health service. That was what world-class commissioning was designed to deliver. We are now asked to turn our mind away from all those ideas.
I, like my right hon. Friend the Secretary of State, am in favour of tax-funded care for patients. I am in favour of equitable access to high-quality care, like my right hon. Friend the Secretary of State and like the shadow Health Secretary. I am also, however, in favour of plural provision, looking for the best solution for patients and the best value for taxpayers. In that respect, I am, as the shadow Health Secretary used to be but apparently no longer is, a straightforward Blairite. This was the breakthrough that Tony Blair taught the Labour party that it now appears to have forgotten. It was Tony Blair who advocated the introduction of private hospitals into the delivery of care and Tony Blair who stressed the importance of the third sector in finding new ways of improving care for patients, yet it is now my right hon. Friend the Secretary of State who has to pick up the Blairite torch that has been so unceremoniously dropped by the shadow Health Secretary.
It is worth reflecting, is it not, on whether this Blairite consensus is the inevitable consequence of the principle of commissioning—
The right hon. Gentleman is in danger of creating another consensus. Indeed, there is a debate about whether the Bill moves things forward as far as the rhetoric suggests. I am on the record many times saying that the claims made for the Bill by, if I am honest, both the Government and the Opposition spokesmen are grossly overstated. It introduces greater engagement by clinicians in commissioning and greater engagement by local authorities in commissioning through the health and wellbeing boards, and those are good things. I agree, however, with the tone of the right hon. Gentleman’s last intervention: the new world is not quite as far removed from the old as he sometimes likes to suggest and as he suggested in his speech.
Let us focus for a second on what it means to have commissioners in the health service. When the shadow Secretary of State has more time one day, I would like to hear him talk us through the process, which he would, on occasion at least, advocate, of turning down a good idea that is brought to a commissioner to improve care for patients and good value for taxpayers because that idea comes from the private sector. I hold no brief for the private or public sector in the delivery of care; I hold a brief for tax-funded equitable access to higher quality care from whomsoever provides that care. That is what I mean when I say that I am a straightforward Blairite and I look forward to welcoming the shadow Health Secretary back into the fold.
I want to speak in support of the motion and argue that NHS hospitals are not private businesses and should not be turned into private businesses, pitted against each other and competing for the most lucrative procedures.
Many of the dangers inherent in the Government’s plans have been displayed in the saga about PIP implants. In that case, tens of thousands of women have been left worried sick about implants received in surgery in private clinics. There are, of course, serious questions about regulation of the products used in private clinics on those tens of thousands of women. Indeed, it has emerged that the PIP implants were effectively counterfeit goods below medical grade, and I understand that some of the gel used in them is designed for use in mattresses.
“no need to routinely remove these PIP breast implants. In the meantime we would recommend that all patients who have questions about their PIP breast implants should seek advice from their implanting surgeon.”
As we have heard since, however, some women who had that surgery could not even contact their original surgeon and many clinics demanded hundreds of pounds even for a scan—money that the women involved just might not have. Last week, many private clinics said that patients must pay in cash to have the implants removed.
I did not feel that the initial advice would reassure the women involved, who were left with all their fears and concerns over Christmas and new year, so I asked fellow members of the Health Select Committee to consider an inquiry into the saga and the issues of regulation that it raised, and I am glad that Committee members agreed and that there will now be an inquiry. We have to remember, however, that reviews and inquiries move slowly for people worried sick about their health. I believe that the NHS should stand by these women, as it reluctantly now seems to be agreeing to do.
The Medicines and Healthcare products Regulatory Agency passed the products despite their being substandard or, as I said last week and previously, effectively counterfeit. I thought that the point was well made in an article by the health writer and commentator Roy Lilley. He wrote that
“women who have PIP made breast implants are the victims of a crime”,
“spent fortunes on enhancements that have turned out to be counterfeit and possibly…injurious to their health… The NHS would not turn away a patient convulsing from consuming counterfeit vodka. Neither should it turn these women away.”
This saga raises many issues about not only the quality of implants but regulation—or the lack of it—in private medicine. That is key to this debate. More issues have been raised in recent days about the ability of surgeons who practise cosmetic surgery in private clinics. Apparently, they are not always trained or skilled enough to apply to be consultants or even to practise in the NHS without supervision, but they are skilled enough to operate alone in cosmetic surgery and private clinics. To what standard do those private clinics operate? What about the many other products implanted in surgery—hips, knees and heart valves, for example? How well regulated are those products and how can we be sure of their quality? I am hopeful that the Health Committee inquiry can tackle some of those regulatory issues.
The concerns raised recently about the cosmetic surgery industry prompt many questions about where we will be if the Government continue with their Health and Social Care Bill. Last week in a letter to The Times, 14 consultants, general practitioners and public health experts wrote:
“The government proposes a vast increase in private provision of health care just as we are told that existing private providers are unable to supply adequate records of what they have been doing and are charging exorbitant sums to consult their records for those women seeking information on what happened to them.”
They continue to warn that the Health and Social Care Bill, now in the other place,
“provides much less protection for patients should their provider fail than is available to people booking package holidays.”
We have to think about that, because the implications are frightening for the future of the NHS.
The other major area of decline is waiting lists—this has been touched on in the debate—which are already getting longer, to the detriment of NHS patients. We must question what will happen when up to half of hospital beds are being used for private patients. In 1997, this country had a Conservative Government and NHS waiting lists were shockingly long. I was out campaigning in the 1997 election with my right hon. Friend the Member for Wythenshawe and Sale East
(Paul Goggins), and I met a man who had been told that he would wait two years for vital heart surgery. He was worried that he would die while on the waiting list. That was the reality of the NHS then.
After 13 years of a Labour Government and while campaigning in my constituency in 2010, I met a man who told me about a totally different experience of the NHS. He visited his GP on Monday and was sent for blood tests. On Tuesday, he was told that he could have serious problems and was admitted to a north Manchester hospital for further investigation. They had a specialist surgeon there who operated on him on Thursday and told him that the surgery had saved his life—four days to save a life in the NHS after a Labour Government had run it for 13 years versus a desperate two-year wait back in 1997 under a Conservative-run Government.
The Health and Social Care Bill challenges the NHS’s founding principle that access to services should be based on need, not ability to pay. I know that my constituents do not want these changes. Many of them have asked me to be here for this debate and to vote for the motion. I am happy to do so.
In conclusion, I join my hon. Friend Grahame M. Morris in mentioning the brave participation of Dr Clive Peedell and David Wilson in running 160 miles in six days to draw attention to the growing campaign to drop the Health and Social Care Bill. It is time the Government listened.
I am grateful to be called, Mr Deputy Speaker. I had three reasons for writing to Mr Speaker requesting to take part in this debate. The first is that I genuinely wanted to hear, in this Opposition day debate on the NHS, what the Opposition’s plans really are for the future of our health service. The second reason is that I want to describe the experience that my constituents went through, over 13 years of a Labour Administration. Finally, I want to talk about how already, in anticipation of the Health and Social Care Bill becoming law, clinicians in Crawley are working to deliver a better national health service.
I do not mind telling the House that I am forgoing an invitation to a dinner this evening, so great was my desire to hear exactly the official Opposition’s view on the NHS. What I have heard this evening is incredible—or, so that I am not misunderstood, not credible. It is amazing that a party that massively increased the PFI programme during its tenure, spending billions of pounds of taxpayers’ money in an inefficient way through the national health service, should come to the House this evening and try to claim that what we are trying to achieve in the Health and Social Care Bill will somehow privatise the national health service. Let us be quite clear: this Government are committed to providing a national health service that is available regardless of the ability to pay. The difference, I contend, between Government Members and Opposition Members is that they are ruled by some sort of centralist dogma that says that if the Department of Health has not willed it, it cannot happen, whereas the Government are trying to introduce a pragmatic approach, in which outcomes are far more important than the strict processes that a dogmatic system for delivering health care should produce.
I said that I wanted briefly to mention the experience of the NHS during what we are often led to believe were the golden years of the health service, under the previous Government. Those years were not so golden for my constituents, because in 2001—a decade ago—we regrettably saw the downgrading of maternity services at Crawley hospital. Crawley is a growing town; indeed, its motto is, “I grow and I rejoice”. However, there was not much rejoicing when its maternity services were taken away and transferred almost 10 miles up the road to East Surrey hospital, where there is now increased pressure on maternity services, as it is having to cope with the increased number of people using those services from not only east Surrey, but the north-east of West Sussex.
To add insult to injury, in 2005 Crawley hospital saw its accident and emergency department closed. Again, it was moved miles up the road to East Surrey hospital, even though there is little public transport between that hospital and Crawley—a growing and ageing town, with increasing health needs and major transportation links, not least the nation’s second biggest airport, London Gatwick—and single-carriageway roads. At best, that is inconvenient for patients and for families wishing to visit them in hospital; at worst, it is potentially fatal. That is my constituents’ experience.
The hon. Gentleman is making a defence of A and E and maternity services, but does he not recognise that, despite the promises made by the current Secretary of State during the election campaign, many hospitals have, for clinical reasons, done the very same thing? They include Salford Royal, which has lost its maternity services, and others in the north-west, even though the Secretary of State promised that that would not happen to them. Does the hon. Gentleman not see that those things are going on now?
The principal reason behind the closure of the accident and emergency unit at my local hospital was the European working time directive, which had a massive impact across the national health service. The NHS as an institution will of course evolve, the better to serve patients up and down the country. That is absolutely right.
That brings me to the third point that I wanted to make: the opportunity that the Health and Social Care Bill will provide for greater localisation in decision making on the future of health care services. I am delighted that the clinicians and GPs in Crawley have already come together to form a GP commissioning body, which is very ably chaired by Dr Amit Bhargava. It is brimming with ideas for innovative ways in which patients can be provided with much better services. For the first time in many years, decisions about the future of health care in Crawley are being made by Crawley clinicians, in conjunction with their patients and in the light of their patients’ needs. The group is working in conjunction with the local authorities—West Sussex county council and Crawley borough council—which, incidentally, will be providing oversight over some of the private sector contracts in the national health service, as envisaged in the Bill. The provision of that democratic oversight for the first time will achieve a localisation of services that is more relevant to the needs of the local communities, as well as a far greater degree of oversight.
I reject the motion before us, and I welcome the Health and Social Care Bill. It will be better for patients and better for democratic oversight. Ultimately, we should be talking about, and delivering, better outcomes for health care in this country, not remaining wedded to an outdated dogma which does not deliver services as efficiently as it could and should deliver them.
The NHS is rightly the most valued institution in this country. It has an impeccable track record of continuing improvement and innovation going back more than 60 years. The staff on the front line and those in the support services who are disparaged by Conservative Members as somehow irrelevant to the success of the service have never been frightened to face up to the challenges of change. They are, however, sick and tired of the constant demands of know-it-all politicians on all sides for endless reorganisations, restructuring and re-profiling. That is why they were so disappointed after the Prime Minister had told them that there would be no more top-down impositions from on high; they and the British public were, quite simply, misled.
The fears around privatisation are a reflection of yet another change to the structure of the NHS, and it is a very unwelcome one. The Secretary of State tried to rubbish the trade unions tonight. He did not mention all the other professional bodies in the NHS that are opposed to the changes. The only people who seem to be in favour of them are those in the Tory party, and their friends in the Liberal Democrats. None of the people who are delivering the services want the changes to happen. That includes the GPs that Henry Smith was talking about. They might well be doing good work in Crawley, but the key is that they do not want to have to do it in that way. The general public are also worried about the changes.
The Secretary of State said that we should not look back, but if we do not learn the mistakes of history, we will repeat them. We need to look at the situation that prevailed a long time ago. The working people in this country in the first half of the last century were desperate for a health care system. People came back from the devastation of world war one to a worldwide influenza epidemic. They were living in desperate conditions and working in massively unsafe workplaces. They were bringing up families whose lives were blighted and shortened by the diseases of poverty: tuberculosis, rickets, malnutrition and pneumonia. Their conditions of life at home and at work had changed little since the days of Dickens, yet we saw yet another world war where money that could not be found to build a decent society in peacetime was miraculously produced to kill millions in wartime.
At the end of that war, the men and women of this country were determined not to continue with that and were not going to put their faith in a Government and a private sector-driven economy that had failed them so badly. They turned instead to a Government who, despite the biggest debt crisis ever, determined that the health and well-being of this country’s people was paramount. That is why Labour built millions of homes for people, why swathes of industries that had been disgracefully run down by the private sector owners were nationalised, and why we, the Labour party, built the NHS to ensure that never again would the quality of a person’s health care depend on the depth of their wallets.
People quite rightly felt bitter about the way they had been treated for decades. That was perhaps best summed up by Nye Bevan, who set up the NHS, when on
“no amount of cajolery and no attempts at ethical or social seduction can eradicate from my heart a deep burning hatred for the Tory party that inflicted those bitter experiences on me.”
As expected, the Opposition did not like that, and Mr Churchill labelled Mr Bevan “the Minister for Disease”. Equally as expected, Nye Bevan was having none of it. Speaking from the platform of the Durham miners’ gala, he reminded people of the reality of life under Tory rule when he said—
The hon. Gentleman is quoting history, so I wonder whether he would agree that Nye Bevan could be seen as the pioneer of private sector involvement within the NHS, given that he accepted that more than 4,000 pay beds should be part of the NHS in order to ensure bags of investment in facilities?
Of course, the reality is as envisaged by my right hon. Friend the shadow Secretary of State, who has accepted that there is a role for the private sector within the health service, but the debate is about how big it should be and how much control there should be of the health sector. [Interruption.] May I carry on?
As I was saying, Nye Bevan responded to Churchill’s criticism by saying:
“Who should be called the Minister for Disease? I am keeping mothers and children alive when he half starved them to death.”
That is the legacy with which the Conservative party is lumbered. It is the burden round the neck of Conservative Members when people of this country get worried about private involvement in health care. I have no doubt that Conservative Members will not agree with me, but it was right and proper when my right hon. Friend Andy Burnham drew an analogy between this privatisation and that of the utilities. We should look at the results of those privatisations: unfettered and uncontrolled expansion, with our energy supplies now controlled by foreign companies; huge, uncontrolled price increases; millions of people in fuel poverty; no control over the security of supply; a national grid not fit for purpose; and an incoherent strategy to face up to the challenge of climate change. Those are all the result of giving away our vital services to the highest bidder. People are quite right to say, “Why would it be any different in health?”
The people of this country do not want the NHS to become a copycat version of the American model—a model that costs twice as much as ours to run, yet leaves 20% of the population out in the cold when they are ill. Our NHS has a tremendous track record, dealing with millions of people every week. Our life expectancy levels have risen rapidly, especially over the period when the previous Government reversed the years of underfunding that were the trademark of the last Tory Government. Public satisfaction rates were at record levels when we left office 18 months ago.
This present Government have broken their promise to the British people. They have lied to the staff who work magnificently to deliver our NHS. They are intent on breaking up the NHS and replacing it with a system based once again on a programme that puts profits before patients. If Conservative Members really believe in privatisation, they should ask the people what they want. The people have woken up to the reality of the Conservative party; they realise that once again the NHS is not safe in Tory hands—even though they are wearing the yellow gloves provided by the Liberal Democrats. Patients, as the figures clearly show, want no further privatisation of our NHS.
Far be it from me to presume to criticise the wise counsel of other Members, but it is absolute nonsense to think that the NHS has always been a monolithic system of public provision. It is absolute nonsense to think that private health providers always think only of profit instead of providing a good service or that services delivered by a public body are necessarily less costly or always better than those delivered by a private provider. It is nonsense to think that choice and competition are never needed, that diversity is bad or that reform or improvement—I prefer that word—is not needed. Sensible, pragmatic, evidence-led arguments can be made for mixed provision, for improvement, for choice and competition, for the involvement of the private sector and for diversity. That is not the problem.
The problem is that pragmatism and evidence count for very little because for the past eight years health policy in this country has been in the grip of an unspoken ideology. Put very simply it goes like this: the Government have no real business in providing health services but should buy them from health providers in a market. Some will be private providers that will make a profit, some will be voluntary bodies or social enterprises and others will be the fragmented, dissected pieces of the old NHS—foundation hospitals, trusts and the like. All can be branded as NHS providers if we want and all can have the NHS logo. The differences between them all will become increasingly blurred and of no consequence. Some people believe it should not matter which of these bodies delivers health services so long as the taxpayer and not the patient pays and the Government keep out of the provider business. That idea is rather like what exists already in other countries, except that generally in those places it is insurance, not tax, that funds the system.
And it is not privatisation. Ministers can truthfully say, “We are not privatising the NHS.” It is marketisation. What is happening is that the Government are buying health in a market, either national or local—an external market. They are gradually giving up on providing health services and in my view clearly mean to do so. It is a beautifully clear, coherent ideology that is rarely explicitly set out, defended, discussed within parties or put to the electorate. Indeed, to do so might be electoral suicide.
Stage by stage over the past eight years that ideology has been progressed. If one assumes it and holds it in mind one can understand why hospitals have to become foundation hospitals independent of the state—that was a Blair idea—and why it was necessary to create a bigger private sector by offering it preferential terms, which was another Blair idea. One understands why services formerly run by primary care trusts, such as community nurses and the like, are being forced to become social enterprises and why it is suggested that NHS hospitals might do up to 49% private work and that private hospitals can do as much NHS work as they like. One also understands why the Health and Social Care Bill abolishes the Government power to start a new hospital, why there is such unseemly haste to extend “any willing provider” and why the Secretary of State, even at the cost of peace in the Lords, does not want the word “provide” back in the list of his powers. If anyone is unpersuaded regarding any of that, let them turn it the other way around and point to one—just one—recent policy initiative that clearly shows that that market solution is not the endgame and the ultimate goal.
I do not believe that ideology is in itself bad, and this ideology has the virtues of being clear, consistent and radical, but in my view it is basically wrong because a health market cannot ensure that health services integrate well—the Future Forum spotted that—or that scarce NHS funds are spent in the most efficient way, as previous Treasury reports have shown in abundance. It cannot ensure that people get the services to which they are entitled and it cannot ensure that health inequalities are properly addressed. It clearly cannot easily make the strategic planning decisions needed to sustain services, encourage training and organise research, which is precisely why these issues have been so problematic in the Bill and why we are going to find slimming down the financially challenged hospital sector so painful and so uncontrollable in its consequences.
I am not here to argue against this market ideology, because, frankly, few have the honesty to argue for it openly. It is not the official Labour policy or the official Liberal policy. I do not believe it is even the official Conservative policy. It was smuggled past all of us, including the general public, shrouded in vague pragmatic talk about choice, diversity, reform and independence, but we should have no doubt: it is ideology. How else can we possibly explain the headlong pursuit at pace of a set of reforms that complicate and make riskier the huge £20 billion efficiency programme? How else do we explain the overloading of bodies such as the Care Quality Commission and Monitor, whose inadequacies, if not apparent now, will soon become painfully apparent after the Mid Staffs inquiry reports?
Does my hon. Friend agree that it would be worth revisiting the issue of whether the NHS should be pre-eminent as first provider or in some other role before we finally make what may be a catastrophic error?
My fundamental point is that this is not evidence-led pragmatism. If we join up the policy dots, we see pure, simple, unalloyed faith in the market system to deliver health in this country. Time after time, in issue after issue, ideology trumps pragmatism and prudence.
The Labour motion is a potpourri of varied sentiments, some of which are true and some of which are confused, and some, given the history, that it is surprising the Opposition have the gall to table at all. However, we should be genuinely grateful to them because they have given us an opportunity—a platform—to name the beast, to define real choice and to cut to the quick.
Chris Mullin, in his excellent “Diaries”, describes a discussion with a fellow Member of this place, a Yorkshire MP, “a mild-mannered fellow”—I do not know who that would include—who in 2005, prophetically, said of the Labour party:
“We’re opening the door…Whatever safeguards we put in place, whatever assurances we give will be absolutely worthless once the Tories are in power…I think we will lose the next election. The Tories will come to some sort of understanding with the Lib Dems—”
I agree with a substantial number of the points made by John Pugh. The Government claim that their proposals are just an incremental extension of the Labour Government’s involvement of the private sector, bringing private patients into NHS hospitals. In fact, they are nothing of the sort; they are dramatically different in nature and scale. To justify them, the Government grossly exaggerate the contribution the private sector has made.
I am sorry that Mr Dorrell has left the Chamber, as in 1997 when I took over from him as Secretary of State for Health, the NHS was carrying out 5.7 million operations. By the time Labour left office, the figure was 9.7 million—4 million more than when he was in charge. Of those 9.7 million operations a year, 9.5 million were being carried out in NHS hospitals and the private sector was doing 200,000, or 2.1% of the total. So much for its massive contribution to improving the service for ordinary people.
The private sector cherry-picked operations and patients, yet now we have the proposition that things will be franchised out; it was to be to “any willing provider,” but now it is to “any qualified provider.” Recent events suggest that it will be to any willing profiteer—to people who are good at the sales pitch and say that they can keep costs down and are superior to the NHS. They will be the people who use the cheapest breast implants and when things go wrong expect the national health service to bail out the patients they have harmed. They are a bit like the bankers: they are in favour of competition and a free market, but when things go wrong, they say, “Will the taxpayer please bail us out?” That is what we are seeing.
We also see in the proposals that the NHS hospitals should in future be able to undertake up to half the work on private patients. The right hon. Member for Charnwood talked about increased revenue. This year sees the 200th anniversary of the birth of Charles Dickens. He had a character called Mr Micawber, and he would have noticed that it is not the revenue that counts, but the revenue against the cost of providing the service. If the cost of providing the service to private patients is greater than the revenue that comes in from private patients, we are running at a loss and the NHS is subsidising them.
In the last year for which figures are available, the Royal Free hospital took in £17.3 million in revenue from private patients. According to the figures it gave me, the cost of providing those services was £15.6 million—an apparent gain of £1.7 million. However, it went on to say that “costs are estimated” and
“not all costs are split between private and NHS patients in this way”.
The costs are not clear. It might look as though the income is clear, but I then asked what the private patient debt is from those people.
No, I do not have time and others want to speak.
The answer is that, over the past five years, private patient debt has never been lower than £6.4 million, against an income of £17 million. They are not exactly subsidising NHS patients out of the private sector income at the Royal Free, because they do not have enough income to subsidise them.
I recall years ago, when I was shadow Health Minister, running a campaign on this issue. The Tory Government said that they would change the rules and introduce a system, backed up by the National Audit Office, as it is now called—then, it was the Comptroller and Auditor General’s office—that ensured that any private sector contribution produced a surplus. No such arrangements were put in place, and I challenge the Minister to identify what the position is with all those private patients in NHS hospitals. How many are running a surplus and how many are running at a loss?
It is always a great pleasure to follow Frank Dobson, but he was rather disingenuous about my right hon. Friend Mr Dorrell. My right hon. Friend said—I think we all agree about it—that where the private sector can add value for money and add value to patient care that always has to be a good thing, as well as something that I think Members on both sides of the House agree on.
My right hon. Friend made the point, which was also well made by Andy Burnham, that this is not a debate about whether the private sector is a good thing or a bad thing in the NHS; it is a good thing, clearly, where it improves care for patients and offers high-quality patient care. The debate is about whether having a cap on the role of the private sector in foundation trusts is a good thing.
It appears that the private patient cap is set arbitrarily and varies from trust to trust. On the basis of what we know, it is difficult simply to argue that having the private sector heavily involved in the workings of a trust is necessarily a bad thing. We know that the 30% private sector activity at the Royal Marsden is hugely beneficial—not only to the private patients, but to those patients looked after by the Royal Marsden who are NHS patients. We see the same at the Royal Brompton, Moorfields and many other hospitals with a relatively high private patient cap. At those hospitals, the money raised from private activities and the private sector is pumped back into the hospital to improve research and to provide high-quality patient care for all NHS patients at those hospitals. Simply saying that having the private sector involved in a hospital to a larger extent is a bad thing because it compromises patient care is plainly not the case. Some of the best hospitals make the case that, in fact, a cap set at a high level is right. As my right hon. Friend the Secretary of State said, at hospitals such as the Marsden, even when they could set 30% private activity, they use only a proportion of that cap, because what they look at first is their primary duty to their NHS patients and their primary duty to provide high-quality care.
It is difficult to argue for a cap set at an arbitrary level, because what everyone in the NHS is interested in, and what we in Parliament are interested in, is producing high-quality patient care. In that respect, my right hon. Friend the Member for Charnwood was absolutely right. Tony Blair believed that, and it was at the heart of his health care reforms. In that respect, the Government are carrying forward the mantra of patients’ best interests.
I have discussed a little the fact that an arbitrary cap does not work, and is not in patients’ best interests. I have also discussed the benefits that involving the private sector in hospitals can bring to NHS patients. The good thing about those hospitals, particularly the Royal Brompton and the Royal Marsden, which are centres of excellence, is the fact that private sector involvement improves the quality and the output of medical research. That is another reason why those hospitals are pioneering examples of high-quality patient research, which benefits patients, particularly in the NHS. This is a good motion, as it endorses the role of the private sector, which can be a good thing as long as it is for the benefit of patients. However, it is a bad thing to impose arbitrary caps that do not benefit patients.
There is no escaping the fact that the role of the private sector in the national health service is one of the most contentious issues to arise when discussing or debating the health service. Some people would suggest that there was no appreciable difference between the policies of the Labour Opposition and the Conservative Government, especially on the use of private companies to deliver services.
I believe that there is a huge chasm of difference, which has been borne out by this debate. It comes down to this: what we saw under previous Labour Governments was the private sector being used to add grit to the system. It operated in the system with strict limitations, and it was deployed, for example, to drive down waiting times from 18 months to 18 weeks. In tandem with targets, the private sector offered a means of improving the efficiency and effectiveness of the NHS, delivering choice and quality to patients. That is where our policies and those of the Government diverge.
It is clear that the intention of the Conservative-led Government is completely different. The NHS is under siege from the Government, who regard the private sector as a means to undermine and weaken the NHS. For all the rhetoric of the Prime Minister and the Health Secretary about their love of the NHS, I would assert that their actions have shown only that they do not fundamentally believe in the principles, values and ethos of the NHS. Those actions attack its very purpose and everything that people hold dear in that world-revered service.
The Government are pushing ahead with their Bill in the face of widespread opposition. Along with the majority of health professionals and the British public, I believe that the Bill should be stopped. Let me make it clear: nothing that I have heard from Health Ministers is reassuring for anyone who has fought to save the NHS. When the Government talk about a regulated market for the NHS people are, and should be, filled with fear.
There will be an increasing role for the private sector, and organisations can be both providers and commissioners. Any A-level business student could explain that that leads to a conflict of interest, and it contradicts and inhibits the notion of introducing genuine competition in the NHS, if that was the intention. I think that the Health Secretary may be mixing up words beginning with “c”. Instead of “competition”, I believe that the word he has been looking for is “cartel”. However it is dressed up, there is one thing I am certain of: allowing such a situation to develop is not in patients’ best interests. There are many questions that need answering. With the private income cap set at 49%, what guarantees are there that hospitals will be able to deliver choice and meet waiting times? What assurance can the Secretary of State give the House that private providers will not cherry-pick the best income-generation services, leaving cost-intensive services such as—
National health services should be provided on the basis of need, not the ability to pay, so I agree.
I was saying that cost-intensive services such as accident and emergency services may well be threatened. How will the overall capacity of the health care market be managed effectively? How would the Government ensure that the proposal did not impact on the ability of hospitals to deliver urgent care?
We have had to proceed very quickly, but there are some major issues to consider. In conclusion, I urge Members to support the motion for the simple reason that it shines a light on how, once again, the Government are developing policy based on ideology and not on what is best for patients. The people’s trust was hard won and the Government have broken that trust yet again. It is another example of ill conceived, poorly developed, incomprehensible policy that we have come to expect from the Government, which leaves Members, the medical profession and our constituents with more questions than answers. A commentator said that the NHS was on the verge of a nervous breakdown. I believe that the way to save it is to kill the Bill.
We have heard much this evening from Opposition Front Benchers about celebrating the role of private providers, but the message that goes out from so many of the Back-Bench speeches that we have heard today is one of fear and alarm. It is the single message “public good, private bad”, and it tries to tarnish every private health care provider with that notion.
I want to use my brief remarks this evening to pay tribute to the staff of the newest NHS facility in my area who are working hard to tackle health inequalities and offering a great service to busy people in my constituency, but these hard-working health workers work for a private sector provider. When they are providing their service in an NHS facility, they must feel mystified and rather let down, I suspect, to be constantly criticised by the Labour party.
I agreed with Liz Kendall, who is not in her place, when she said in 2008 that the private sector has much to offer in tackling health inequalities. That is what that NHS facility run by Care UK is doing in my constituency—tackling health inequalities, helping busy, highly mobile young people who cannot register with a GP to get the service that they need, and helping shift workers, migrant workers and those whose working day starts too early for them to get to the doctor during normal hours.
The Junction health centre in Clapham junction, a busy transport hub, opened in March 2010. It was commissioned in 2007-08 and provided by Care UK, a private sector provider but an NHS facility, working to agreed NHS standards. Yes, the Opposition should take pride in having commissioned it. Instead, we see them rowing back from that previous sensible pragmatic position. The facility in my constituency is an excellent example of partnership working, and it is providing care for my constituents. They judge it as an NHS facility. They do not worry about who is providing the care. They worry about the quality of the care and service being provided, and they are voting with their feet.
The target that the facility was set was 2,000 patients by March 2012. There are already well over 3,000. Many of them were not registered with a GP before. The facility is registering homeless patients. How much more universal a service can there be than that? It deals with unregistered walk-in patients—more than 30,000 last year, and in many cases people who would not otherwise have got to see a GP. This is all good. But what do we hear from Labour Members? They talk it down. A previously consensual position on private sector provision is now incredibly polarised around an ideological position that suits this Parliament. Alan Milburn was right when he said in 2009:
“Quality should be the only yardstick, not the type of provider.”
The thousands of people who have attended the Junction health centre in Battersea over the past two years are being well served by hard-working and dedicated health professionals. It might suit the Opposition for narrow party reasons to denigrate the efforts of those health workers who work on behalf of the NHS, but I want to pay tribute to them publicly and say how glad I am that they are providing this much needed and greatly appreciated NHS service, free at the point of delivery, to my constituents. I oppose the motion.
Private sector involvement in the NHS will always be an emotive and contentious subject. As members of the party that founded the NHS, we on the Labour Benches are clear that there are, have been and always will be times when the private sector can and should provide an important function in supporting the delivery of NHS care, but recognising that role is in no way comparable to opening up the NHS to full-blown privatisation, which is the clear intention of the Government’s Health and Social Care Bill, a shambolic piece of legislation that is quickly acquiring the same level of popularity as the poll tax. There is a world of difference between using private providers to support the work of the NHS and privatising the NHS. This legislation and the Government’s desire to set free the ravages of the market on what we believe to be the country’s most treasured institution commands no public support and no democratic mandate.
The reality is that the NHS, as a publicly owned and publicly funded world-class health care service providing medical care free at the point of need, is one of the defining institutions of our society and one of the most important hallmarks of our national identity. Established in the aftermath of the greatest conflict our country has ever faced, the NHS was built by a tired nation and an exhausted people from the wreckage of the second world war. They knew that it would help to build a better country and that it could not be done by the private vested interests that so bitterly opposed its creation, and they were right. Every Member of Parliament must recognise that to the people we serve and to our country as a whole the NHS is more important that any of us, collectively or as individuals, and that it is much more important, more trusted and more respected than any one of the political parties represented in the House.
Politicians across the House must recognise that they damage the NHS at their peril. The public do not want the NHS to be opened up to the market, because they know where that leads: the wealthy customer will take priority over the patient in need. The Government know that the public would never have voted for any party with that objective at the heart of its health policies. For that reason, the privatisation of the NHS is being undertaken by stealth. It was a former Conservative Secretary of State, Michael Portillo, who told the BBC’s Andrew Neil last January that the Conservatives
“did not believe they could win an election if they told you what they were going to do because people are so wedded to the NHS.”
We in this Chamber are often too slow, too ungracious and, frankly, too partisan to pay tribute to those outside our own parties when tribute is deserved, so I now commend the four Liberal Democrat MPs who voted against the Bill on Second Reading. They did so not simply because it was not in the coalition agreement and has no democratic mandate, and not just because they recognise that the NHS is bigger and more important than any of us or the fortunes of any political party, but because they recognise that the Bill paves the way for the privatisation of the NHS. May I just say “Ahoy” to the Education Secretary, who has just entered the Chamber?
To paraphrase Andrew George, for whom I have a great deal of respect, those Liberal Democrats at least did not want to become the architects of the NHS’s demise.
We have heard many promises from the Prime Minister on the NHS, none of which, sadly, is backed up by his or his Government’s actions. He promised real-terms increases for the NHS, but in his first year in office he delivered a real-terms cut. He promised no top-down reorganisation, yet he delivered the biggest and most unwanted reorganisation since the NHS’s creation. Most sickeningly of all, he played fast and loose with the trust of health campaigners across the country when he promised a bare-knuckle fight against hospital and ward closures. Now the Department of Health talks openly of nationwide hospital closure programmes, and wards and services are being lost all over the country.
It is essential to listen to health professionals on matters of health service reconfiguration, but it is deceitful to pretend to oppose those reconfigurations, to trade on the hopes and fears of ordinary patients and to say one thing in opposition and do another in government. But it is perhaps the Prime Minister’s assurance of “no privatisation” in the NHS, given in May last year, that illustrates that pattern of behaviour most clearly.
Last year, Mark Britnell, one of the Prime Minister’s hand-picked health advisers, told a conference of private health care providers:
“In future, the NHS will be a state insurance provider, not a state deliverer.”
“The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years”—[ Interruption. ]
I advise those Government Front Benchers who are chuckling—perhaps the bars have closed early—to dwell upon the phrase “no mercy”.
With the shambles of a Bill plunged into crisis, the Prime Minister was forced to demonstrate that he was across the detail of the legislation, and in a speech at Ealing hospital he said:
“Let me make clear: there will be no privatisation… These are red lines we will not cross.”
Yet just before the Christmas period, perhaps ignorant of the Prime Minister’s guarantee or based on the fact that there is no mandate for the changes and the Government are not in the habit of ever doing what they say they will, the Secretary of State tabled amendments to his health care Bill which would allow NHS hospitals to devote 49% of their beds and theatre time to private patients, opening the door to an explosion of private work in NHS hospitals and inevitably resulting in longer waiting times for ordinary NHS patients and widening health inequalities not just between but within different communities throughout England.
I therefore call on the Government to answer this simple question: how can it be right to allow the wealthiest in our country to use publicly funded services, paid for by the taxes of those most in need, to jump the NHS waiting lists that are now growing under this Government?
That is a Mickey Mouse policy, and speaking of Mickey Mouse I should say that Members who have been to Disneyland or any other holiday park for that matter—perhaps on a Tory party policy seminar—will have seen fast-pass systems in operation. The fast-pass system works in exactly the same way that the Government hope 49% private sector involvement in the NHS will: everyone pays to get into the theme park, the queues are too long so the richest pay more to beat them, and eventually all but the poorest buy the fast pass and the queues become as long as they were in the first place. The only difference is that everyone ends up paying double for the same queues they were suffering at the beginning.
The Prime Minister may not want to admit to the privatisation of the health service, and he may not be able to acknowledge that his attempt to change his party, based on a cosmetic change of attitude to the NHS, was never real and was always hollow, but the inescapable reality is that his Government, through the Health and Social Care Bill, are taking a sledgehammer to Britain’s most valued public service by not simply allowing but encouraging, as a matter of principle, a private sector free-for-all in England’s health service.
That is why in a speech in November last year the Prime Minister stated that he wanted the NHS
“to be a fantastic business for Britain”— a line strangely omitted from the official transcript of the speech—[ Interruption. ] The Minister of State, Department of Health, Mr Burns, chunters from a sedentary position, but he himself told “Newsnight” in January last year that the Prime Minister’s Bill would turn the NHS into a “genuine market”.
Labour Members believe that the NHS is an unprecedented force for good in our society, the mainstay of so many of our communities and the guarantor of a fairer, better society. We believe it speaks to who we are and what kind of nation we aspire to be. It is not the Prime Minister’s to sell, and it is not for sale.
“I don’t want you to trust David Cameron…he has values that I don’t share.”
The Minister was right then, and if we listen the to the rank and file membership of the Liberal Democrats we find that that is what they believe now.
The inescapable reality is that the Liberal Democrats find themselves in a constitutionally and historically unique position. They can now determine the future of the NHS in England, as either a world-class public service treating people equally, providing medical care to those who need it and free at the point of use, or as a fragmented, US-style health system, which will see publicly owned hospitals, publicly funded services and health professionals employed by the public purse giving up 49% of hospital beds and theatre time not to those who need them but to those who are most able to pay for them. That is an enviable responsibility, and the Liberal Democrats Members can stop that creeping, stealth privatisation of the NHS. The Minister was right to distrust his Prime Minister, and his party colleagues can stop this attempt to take a wrecking ball to the NHS as we know it.
“What we will see with private providers is a fragmentation of the NHS, with no accountability…we will see the diminution in the quality of care. And unfortunately what we are seeing with the breast implant scandal is the future of the NHS, it will be destroyed.”
Tonight, the Secretary of State has dissembled and fumbled his way through an attempted defence and explanation of the Bill, but he could not provide it. He does not know what he is for, what he is against, what he is replacing or what he is introducing. It is no wonder that the medical profession neither believes nor trusts him. He either does not know what his policy is or he is afraid to say. The country deserves better. This is now a bare-knuckle fight and the Government must think again.
To begin on a conciliatory note, I congratulate Mr Reed on his first speech from the Front Bench as a junior shadow Health spokesman. I did not agree with a single word that he said, but I congratulate him on the way in which he spoke.
I have no idea what new year resolutions the Labour party has made, but perhaps I could suggest one: to get their facts right. Having listened to the endearing speech of Frank Dobson, the same speech that I have heard on many occasions from Grahame M. Morris, the slightly bizarre speech of Mr Anderson and the speech from Rosie Cooper, I have to say that they really have got it wrong. It is wrong to seek to misrepresent by repeating a fallacy.
I congratulate my right hon. Friend Mr Dorrell on his lucid exposé of the contradictions in the arguments of Andy Burnham. I thank my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter), for Crawley (Henry Smith) and for Battersea (Jane Ellison) for their thoughtful contributions. I listened carefully and with great interest to the speech by John Pugh but, to be honest and frank, I was not carried along by the strength of his argument on the issues.
I fear that many of the contributions of Opposition Members that my hon. Friends and I have had to listen to have given a series of misrepresentations and misinformation. I remind them that for 36 years, just over half the 64 years of the national health service, it has been under the stewardship of the Conservative party. We have never sought to privatise the health service and we never will privatise the health service.
I did not in any shape or form suggest that the right hon. Gentleman’s figures were wrong. I argued that his arguments and his philosophy were wrong. They are based in a past time that is pre-Blair, let alone Blair, which I know is now anathema to the Labour party. Ironically, one might say, as I think did my right hon. Friend the Member for Charnwood, that Government Members, in this respect, are all Blairites now.
Rather than pour scorn on an invented problem, the Opposition should welcome the healthy relationship between the national health service and private providers—a relationship that is mutually beneficial, that has existed since 1948, that is better for patients and, I hesitate to remind the right hon. Member for Leigh, that flourished under his Government. The last Labour Government expanded the involvement of the private sector in the provision of NHS care in a way that no previous Conservative Government had done. Labour’s general election manifesto of 2010, which was written by the current Leader of the Opposition, said:
“We will support an active role for the independent sector working alongside the NHS in the provision of care”.
Rather more surprisingly, given the nature of today’s debate, the Labour manifesto also stated:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
To reinforce that, it went on to promise to remove the private patient cap on foundation trusts. In addition, on
I remind Members of the benefits of extra income to the NHS, which are so clear as to be self-evident. Any and all money made by the NHS is returned straight into care, not to the Treasury. The principal purpose of NHS providers has always been to serve NHS patients, and that will not change. In fact, trusts say that changing the cap will help them do that better than ever. The Labour party knows that. In 2009, the then Health Minister, Mike O’Brien, said that to cap the number of private patients would be nothing but a sop to militant Labour MPs. It now seems, though, that they are all militant Labour MPs.
I know that he has not been the flavour of the month for a while now, but as none other than Tony Blair once said, the private sector
“has got a valuable role to play in delivering NHS services.”
Even Mr Brown called for greater use of the private sector.
I wish to take a second to look at the last Government’s record on using the private sector. Through choose and book and through giving patients the right of the choice of provider, the number of patients treated as NHS patients in the private sector escalated. Under choose and book alone, the number of procedures increased from only 11 in 2000-01 to more than 208,000 10 years later. By May 2010, more than 7% of all NHS-funded first out-patient appointments were booked with independent sector providers. In money terms, between 2006 and 2010, £12.6 billion was spent in the private sector on NHS health care.
Let us pick an example at random—say, independent sector treatment centre contracts. “Wonderful things”, said Labour. “Cutting waiting times”, it said. What happened? Private companies being paid even when they had not treated any patients; hundreds of millions of pounds being taken from the public purse and wasted; and the NHS barred from competing with private companies, even if it could offer a better service. What is more, seven of those ISTC contracts were signed while the right hon. Member for Leigh was a junior Minister at the Department of Health—hardly a glorious record.
My hon. Friends and I had a while in opposition, and I know how uncomfortable the Benches on that side of the House are. They make people itch—itch to disagree with everything that is said by Government Members. However, I say to the right hon. Gentleman that it is wrong to scaremonger about the role of the private sector in the NHS. As he found out in government, because his Government greatly expanded that role, there is a responsible role for the private sector not at the expense of the NHS but working with it. On that basis, I urge my right hon. and hon. Friends to vote against the motion.