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.