I beg to move, That the Bill be now read a Second time.
Today we begin to restore the sovereignty of this House over our national health service. We begin to put patients at the heart of decision making. We will restore the responsibility of the Secretary of State to promote a comprehensive national health service. We will tear the heart out of the hated Health and Social Care Act 2012. We will remove the health service commissioners’
obligation to put services out to tender. We will replace the 49% private patient cap, and allow the Secretary of State to set limits. We will prevent competition authorities from interfering in mergers that are in the interests of NHS patients. We will stop the sale of assets that are in the long-term interests of patients and our national health service. We will restore the powers of the Secretary of State to direct health commissioners. We will create a framework for national health service contracts that will put the interests of patients before competition. We will protect the NHS from the imposition of competition rules by the transatlantic trade and investment partnership, and give sovereignty to this House.
Through this House, the Secretary of State will be accountable for promoting a comprehensive national health service. If any Government dare to impose competition on our national health service in the future, they will have to come before the House and repeal this Bill, if it becomes an Act. We, as Members of the House, will be accountable to our constituents for how we vote in that debate. There will be no hiding place.
Some have expressed the fear that the Bill opens the door to further privatisation. It does not. I accept that the last Labour Government unlocked the door to competition, albeit in a modest and measured way. I voted against the creation of hospital foundation trusts, which introduced legally binding contracts with NHS commissioners; in retrospect it was a mistake, because it brought procurement law into parts of the NHS.
I congratulate the hon. Gentleman on being so lucky in the draw. He has referred to competition. Does he not accept that Labour did much more than he is suggesting? The then Secretary of State, who is now the shadow Secretary of State, privatised an entire hospital in the east of England. That is privatisation. [Interruption.]
It is not possible to compare what went on under the last Government with what has been introduced by the raw market mechanisms of the 2012 Act.
I, too, congratulate my hon. Friend. Is he aware that in north Staffordshire, cancer and end-of-life care is going into the private sector on a 10-year contract worth £1.2 billion?
There are numerous examples of contracts that are going out to tender, and the cost to the national health service of lawyers and accountants is increasing. The Government have made so much of the issue of bureaucracy in the NHS, but when I asked the Secretary of State about the cost of those lawyers and accountants to oversee the tendering process, what was the response? It was, “We do not collect those figures centrally.” I wonder why that is.
I have no need to apologise, because I voted against it. I was actually about to give the hon. Gentleman credit for introducing this Bill, which I look forward to supporting, and for his role in opposing some of the things that the Labour Government did. Does he welcome the fact that the £800 million tender for older people’s services in Cambridgeshire stayed within the NHS? Does he also accept the concerns that many of us had about the contract at Hinchingbrooke that was put out to private tender by the last Labour Government? I am sure he would agree that that was a problem.
It is just not realistic to compare what went on under the previous Labour Government with what is going on now. Yes, the contract in Cambridgeshire, at Peterborough, was won by an NHS bidder, but what was the cost? How much money was diverted from patient care into running that tendering process? That is an increasing cost to the NHS that we cannot allow to continue. By the way, I unreservedly withdraw my accusation that the hon. Gentleman voted in favour of the 2012 Act, because that is a calumny I would not use against my worst enemy.
Through the House, the Secretary of State would be accountable—
I am delighted to help the hon. Gentleman out. Helpful as ever! He talks about stopping what he calls privatisation and about putting the Secretary of State in charge. At the moment, there is a cap on the amount of private income that a hospital trust can gain, but does he agree that clause 7 of his Bill would remove that cap, giving discretion to the Secretary of State? Does he acknowledge that the amount of private income a hospital could receive could actually go up under his Bill?
There are a number of provisions relating to the Secretary of State which state that everything that is decided has to put patients first, rather than competition. That is the key difference in this Bill. The Secretary of State will have to be satisfied that every penny raised from private income serves the needs of patients. The Secretary of State will set the limit, which can be variable, but it will have to come down because this House will demand that.
My hon. Friend is absolutely right. There are too many examples of money being wasted on the tendering process.
Those who suggest that what the Labour Government did can be compared in any measure with what this coalition has inflicted on our national health service are completely misguided. When the Labour Government were elected in 1997, we spent 5.2% of our GDP on our health services. In 2010, we had increased that to 8.6%. We increased the number of doctors by 48,000. We increased the number of GPs by 5,000. We increased the number of training places for doctors, which had been cut by the previous Tory Government. We increased the number of nurses by 70,000. We had the biggest hospital building programme in the history of the national health service. We rebuilt or refurbished every accident and emergency department in the country. When Labour left office, the NHS had the highest satisfaction ratings from its patients that it had ever had in its history. The NHS was in crisis in 1997, and Labour saved it. It is in crisis again now.
The hon. Gentleman was on the Bill Committee for the 2012 legislation, and I wonder how many amendments he tabled to put those issues right. And he has the cheek to come here and ask questions about my Bill, which seeks to put right what he did not attempt to put right when he was on that Committee.
I congratulate my hon. Friend on getting this Bill to its Second Reading debate. The Government have been throwing all these facts and figures at us about how the number of doctors is increasing all the time, but these things started under Labour, It takes seven years for a doctor to be a decent practitioner, and we are the ones who made a start on this, not the Government.
My hon. Friend is absolutely right: the claim that this Government, whose top-down reorganisation has caused so much chaos in the national health service, are responsible for the standards of the NHS now is laughable. They claim to have turned the NHS around in a short space of time, but they are standing on the shoulders of the achievement of the previous Labour Government.
My hon. Friend is absolutely correct, and another way of putting it is as follows: we dragged the national health service, between 1997 and 2010, from the depths of degradation that the Tories left it in and hoisted it back to the pinnacles of achievement. I have got a united nations heart bypass to prove it—it was done by a Syrian cardiologist, a Malaysian surgeon, a Dutch doctor and a Nigerian registrar, and these two people on the Bench behind me talk about sending them back. If you did that in the hospitals in London, half of Londoners would be dead in six months. Those are the facts about the United Kingdom Independence party.
I congratulate my hon. Friend on introducing this Bill. Does he agree that the Liberal Democrats have got a brass neck in making criticisms, given that not only did they sit on their hands during that Bill Committee, but Paul Burstow was the prime advocate who led the Bill during its passage through Parliament?
I, too, congratulate my hon. Friend on his Bill. He also carries the congratulations of 1,924 people from across Chesterfield who have signed a petition asking me to be here to support his Bill. He is not just speaking with people behind him here; people right across the country are saying, “Thank you very much for what you are doing.”
I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.
I hope the hon. Gentleman does not mind, but I am going to make some progress.
Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.
We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.
I congratulate my hon. Friend on securing the Bill’s progress today. Does he agree with my constituent Julian Corlett, who expresses real concern that further privatisation would mean the NHS may be reduced simply to a brand and nothing more?
Absolutely. It is the capacity of the NHS to continue to provide services in the future that is under threat. Eventually and inevitably, with continuing privatisation of all its services, the NHS will end up as just a patchwork of contracted-out services, and that will put us at the mercy of the private sector.
The hon. Gentleman talks about money being diverted away from patient care and about extended privatisation, but will he comment on the private finance initiatives that the previous Labour Government imposed right across the NHS, bankrupting many of its institutions and taking money away from patient care?
There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.
My hon. Friend is making a good case. Is it not the truth that the one constant over the past quarter of a decade is that both Governments—they are equally matched in this—did not listen to the people who really knew about the NHS? I am talking about the people who work in the service. To be honest, our Government, to their shame, ignored the working people and those in the NHS who said do not go into PFI or foundation hospitals. Exactly the same thing happened in 2012 when the Tory party ignored the same voices of the people who were saying, “Don’t go ahead with this Act.” We should start listening to the people who know what they are doing—the people we rely on to deliver NHS services.
All Governments have lessons to learn. This party is not saying that it has nothing to learn, but it wants to end the privatisation of the national health service. We must understand one thing: next May is when we have to fight to save our national health service. If we continue under this Act to keep privatising our services, we will not have a national health service as we understand it.
Like me, is my hon. Friend amazed by the faux indignation of some of the Government Members? Those Members will be the ones who will benefit from the donations of some of the private sector companies that are winning the contracts in our NHS service.
We have seen the names—64 of them. We will see how they vote today, and then let the public know what they are doing with our national health service.
I should like to make some progress. The Bill is in four parts. Part 1 deals with the powers and duties of the Secretary of State. It reinstates the legal duty of the Secretary of State to promote a comprehensive national health service. It gives powers of direction to the Secretary of State over NHS England and local commissioners. It also requires the Secretary of State to put the needs of patients above those of the providers, or the market within which providers operate. It also provides that all contracts will be deemed to be “NHS contracts”. The significance of that is that they will not be subject to competition rules. All complaints will be dealt with within the framework of the NHS, with the Secretary of State having the final say—not lawyers or the courts.
I am grateful to my hon. Friend for giving way and for securing this private Member’s Bill. One urgent issue that we must address is that of the purchaser/provider split. Will he assure us that the proposals in this part of the Bill will mean that health services can be run purely on health grounds?
The Bill does not attempt to rid the NHS of the purchaser/provider split. That would require a new top-down reorganisation of the national health service, which people in the NHS say they do not want. What I can say is that this Bill will create a framework in which NHS contracts are not open to competition rules. As long as the commissioners of services stay within the confines of the NHS contracts, they will not be open to competition. They will be compelled to do that by sheer cost, because if they step outside of NHS contracts they are then into European competition rules and will have to spend millions on lawyers and accountants to oversee the tendering process.
I shall make some progress before giving way again.
Part 2 deals with the private patient income. It empowers the Secretary of State to set the cap and reduce it from 49%. It also ensures that any income derived from private care is in the interests of NHS patients.
Part 3 gets to the core of the issue. It repeals the sections of the 2012 Act that require health service commissioners to put services out to tender, particularly the hated section 75. Clause 9 provides that no legally enforceable procurement obligations shall be imposed on NHS commissioners in relation to any arrangement that is proposed to take effect or takes effect by way of an NHS contract. It further provides that commissioners who place NHS contracts shall not be within the scope of the Public Contracts Regulations 2006.
That provision ensures that article 168(7) of the treaty on the functioning of the European Union is given proper effect in UK domestic law. The article states:
“Union action shall respect the responsibility of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of resources assigned to them.”
This provision prevents the market from interfering in mergers of services and makes it clear that the disposal of assets will require the permission of the Secretary of State. The Secretary of State will exercise his duties in the interests of patients.
My hon. Friend is making one of the best speeches we have heard in this Parliament about protecting our national health service. Does he agree that another way we could prevent private providers from competing in the national health service would be by persuading this Tory Government to exclude the national health service and other public services from the transatlantic trade and investment partnership negotiations?
My hon. Friend has guessed the next part of my speech. Part 4 of the Bill deals with TTIP. I have heard some criticisms that the Bill does not protect the NHS from TTIP. Clause 14 reads:
“No ratification… of the proposed Transatlantic Trade and Investment Partnership Treaty shall cause any legally enforceable procurement or competition obligations to be imposed on any NHS body entering into any arrangement for the provision of health services in any part of the health service.”
There are differing legal views on whether the proposed TTIP will or will not impose legally enforceable procurement or competition obligations on the NHS. However, without this clause the question of which set of highly paid lawyers is right will be decided only after the treaty is signed and will be a decision for the courts, not the elected Government. I am sure that is music to the ears of Government Members.
My hon. Friend may be aware that in response to a question I asked him this Monday, the Prime Minister indicated that he thought the health service would not be affected. He seemed to be suggesting that he did not want it to be affected. If that is the case, surely his Government should be supporting this provision to ensure that does not happen.
My hon. Friend is absolutely right. We know that the Prime Minister has accepted it was a mistake, so the Government’s position on the Bill is a bit curious.
I congratulate my hon. Friend on securing this Second Reading debate. He made an important point about the provisions applying across the United Kingdom: Wales, where the policies are different from those operating across England, would still come under the TTIP agreement, so it is important that this clause is included.
Absolutely essential. The question for the House is whether that policy issue should be decided by Parliament or the courts. Clause 14 is either unnecessary or essential, depending which set of lawyers ends up being proved correct. We say it should be a decision for Parliament, not the courts. Clause 14 puts the matter beyond doubt.
The public must decide whom they trust with the NHS. Do they believe the Tories who say they will protect it? After all, the Tories said there would be no top-down reorganisation, they said there would be no closure of A and E departments, they said there would be no closure of maternity units except where local people agreed.
I am grateful to my hon. Friend for allowing me to intervene, in addition to my main function today, which is to provide a cordon sanitaire. [Laughter.] I am very pleased that my name appears on the Bill as one of its supporters because nowhere is it more apparent than in west London what the Tories mean for the NHS. Two A and E departments closed, and within weeks up to a third of patients were not seen within four hours at A and E. Does my hon. Friend agree that unless we get rid of all this Tory legislation, the NHS will not survive?
My hon. Friend is right. Before the election the Tories said that they would seek the agreement of local people in decision making, but in south-east London in 2007 my local health managers published a document called “A Picture of Health”. It was drawn up by doctors, nurses and midwives. They held a conference and reviewed all our services. They came to politicians like me and said, “We want you to behave sensibly. This is about improving the quality of care for patients, but at A and E it is also about saving lives.” Just before a general election, it is quite a thing for people to say, “We’re going to close one of your A and Es.” I differed with the health managers over which A and E should close, but when clinicians come and say, “We can save lives and improve quality of care,” we have to listen.
That is what the Government said they would do. What happened? The then shadow Secretary of State for Health, Mr Lansley, came to the A and E proposed for closure in “A Picture of Health”, marched around the area and told local people, “We’re not going to close your A and E.” What happened then? The Tories got into Government and closed the A and E. In London they put nine out of 31 A and E departments under threat, then they attempted to force the closure of Lewisham A and E. When they were beaten off by local people, they took powers to themselves to close it over the heads of local people.
Now, my constituents who get in an ambulance are handed a leaflet that says, “If you come from SE9 or SE3, you can’t go to the local A and E at the Queen Elizabeth.” Where do they have to go? You guessed it: Lewisham. But Lewisham A and E would not have been there if the Government had had their way. On top of that, the Care Quality Commission has condemned A and Es in our area because of lack of resources and lack of capacity. At the same time the CQC commended the staff for their dedication in keeping the service running, yet the Government would have closed Lewisham
A and E. So, what of their pre-election commitment not to do anything over the heads of local people or local health managers?
Do we believe the Tories when they say the NHS is safe in their hands? [Hon. Members: “No.”] To defend the NHS, one has to believe in the founding values that led to its creation. Our NHS treats everyone equally—from each according to their means, to each according to their needs. Are these the values of the party that gave us the poll tax or the bedroom tax, or the party that plunges thousands of disabled people into poverty by denying them benefits and forcing them through an unending cycle of appeals to get what they are entitled to?
Throughout history working class people have had to fight to assert the undeniable truth that all men and women are created equal. From the very first poll tax rebellions, John Ball asked:
“When Adam delved and Eve span, who was then the gentleman?”
He educated common people that they were all created equal. It is a theme that working class people have been forced to return to throughout the centuries, whether through Christianity or a political fight for social justice from the Levellers to the Diggers, from Thomas Paine and the Chartists to the trade union movement today. These are the people who fought for the values that created the national health service. There is nothing in our society today that embodies those values more than our national health service. It is these values that cannot be defended by a party that talks about fairness while it justifies the bedroom tax and measures people’s worth. That is not what our NHS does.
This Bill will not solve all the problems in our national health service—it will take a Labour Government to rescue it from a crisis—but it is an essential step in rebuilding our national health service.
Mr Speaker, I do not beg to move that this Bill be read; I demand it be read, on behalf of NHS patients, on behalf of the staff—the nurses, the doctors, the support staff, the carers, the volunteers. On behalf of everyone who holds our national health service dear, I move that this Bill be read a Second time.
I congratulate Clive Efford on introducing his Bill and on the robust candour with which he did so. I am only sorry that he was displaced from his usual perch in the House. However, I am confident that when, after the next general election, the Labour party finds itself again in opposition on those Benches, Labour Members will not have to share them with the UK Independence party because we will have won those seats back.
I can understand why, when there was a coalition Government at the start of this Parliament, the Liberal party wanted, as a condition of the entering into the coalition Government, a five-year fixed-term Parliament. However, one of the difficulties and drawbacks of five-year fixed-term Parliaments is that we have some of the longest general election campaigns ever, and that makes it quite difficult to differentiate substantive and serious political points and what is essentially electioneering.
I can just imagine the hon. Gentleman making that speech on a wet Thursday evening during the general election campaign in the trades hall somewhere on Eltham high street.
Does my right hon. Friend agree that it is good to hear an authentic south London voice speaking up for Labour values rather than the snooty lot from north London who manage the party now?
Yes, but the first point I want to make is this. We need to be careful about what we say about the NHS in the run-up to general elections. The first general election campaign that I was seriously involved in was back in 1966. In every one since then, there has been a period when the Labour party has run around saying things along the lines of “24 hours to save the NHS.” That is very destabilising, as was evidenced today in a letter to a national newspaper by Dr Michael Dixon, the chairman of the NHS Alliance, and a number of other GPs, in which they say:
“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.
The Bill’s proponents claim it will remove competition from the NHS and guard against ‘privatisation’ by repealing key clauses of the 2012 Health and Social Care Act.
We believe this would be a backwards step for patient care, reorganising the NHS in a top-down way at a time when it needs to be looking ahead to the huge challenges of the future. These were set out in the NHS England Five Year Forward View, and we urge all politicians to support it rather than using the NHS as a political football.
Suggesting that GP commissioners have a ‘privatisation agenda’ is an ill-informed attack on the clinical leadership which improves services and helps patients.”
I agree. It is disappointing if politicians use the NHS as a political football.
The NHS is an enduring part of the post-war consensus on the welfare state. That consensus was agreed on by everyone who had gone through the deprivations of the second world war, had lived through the blitz, and were determined that there would be a better Britain. The NHS was supported by everyone, including Archbishop Temple, a brilliant Archbishop of Canterbury, who was the person who first coined the phrase “the welfare state”.
I have always been interested in the NHS, not least because both my parents became part of the NHS on its very first day. When it came into being in 1948, my father was a recently qualified registrar and my mother was a theatre sister, having served as a theatre nurse during the Coventry blitz. My parents spent the whole of their working lives in the NHS: my father went on to become the research secretary of the British Tuberculosis Association and a chest and heart specialist, and my mother went on to become a sister tutor.
The other reason I have always been extremely interested in the success of the NHS is that, in the nearly third of a century I have been fortunate to be the Member of Parliament for north Oxfordshire, the most important issue in my constituency has probably been the position of Horton general hospital and the retention of its services.
I have left instructions in my will that my body should go to the anatomy department of the university of Oxford, partly because there is quite a lot of it for them to work on, but also because I feel that the liver of anybody who has been an MP for nearly a third of a century must be worthy of some anatomical research. I am also determined that when they open me up, they will discover engraved on my heart, “Keep the Horton general.”
What we heard from the hon. Member for Eltham was a litany of gloom in the NHS, but Horton general hospital now has more consultants than at any time in its and the NHS’s history. The Oxford University Hospitals NHS Trust employs 11,598 staff, including 1,800 doctors and 3,600 nurses. It is important to make clear that, since 2010, the number of patients seen by the trust, including at Horton, has increased significantly. There has been a 19% increase in elected in-patient admissions, a 9% increase in emergency in-patient admissions, a 24% increase in day-care admissions and a 12% increase in out-patient attendances. Those are significant increases in just over four years, so the NHS continues to treat more out-patients and in-patients.
Over the past two years, the Oxford University Hospitals NHS Trust has managed completely to eliminate its financial deficit and increase the amount paid to the Oxfordshire clinical commissioning group, such that the group finished the year with a surplus. Most importantly, over the past couple of years the trust has managed to create 400 new jobs, almost all of them new doctors and new nursing posts. Sir Jonathan Michael and his team deserve considerable congratulations on managing to balance the finances of the trust and securing a large number of new medical and nursing posts.
Does the right hon. Gentleman think that all those things would have been achievable had the level of funding for the NHS continued at the rate we inherited in 1997 and had Labour not almost tripled the amount of GDP put into our health services?
Every Government have invested money in the NHS, and quite rightly so. This Government have invested real-terms increases in the NHS, as evidenced by the Commonwealth Fund, which compares health systems internationally. It found this year that, although the United States health care system is the most expensive in the world, it underperforms relative to other countries on most dimensions of performance. The fund studied 11 nations: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The United States ranks last, but who ranks first as the best health care system in the world? The United Kingdom. We should all, wherever we sit in this House, be proud that we have the best health care system in the world.
I am not entirely sure what point my hon. Friend is trying to make. The fact is that the Commonwealth Fund found that the NHS is the best health care system in the world. I hope that he and everyone in the House takes pride in that. The NHS has many challenges—we are all conscious that with an ageing demography and advances in medical technology, every health care system faces challenges—but we should take pride in being the best.
We also need to be honest about what has gone before. There was an enormous amount of rewriting of history and revisionism in the speech of the hon. Member for Eltham. For those of us who have been in the House for some time, it may be worth looking back and reminding ourselves about what happened in the not-too-distant past.
“This NHS Plan sets out the steps we now need to take to transform the health service so that it is redesigned around the needs of patients. It means tackling the toughest issues that have been ducked for too long.”
I do not think anyone would ever disagree with that as a statement of intent. He went on:
“For the first time the NHS and the private sector will work more closely together not just to build new hospitals but to provide NHS patients with the operations they need.”
My hon. Friend makes his own point very well in his own way. It is important for all of us to remember that the NHS is our NHS and our constituents’ NHS. It does not belong to any particular political party; it is a national heath service.
Alan Milburn concluded that the “major reforms”, which included working more closely with the private sector, would
“deliver real benefits for NHS patients”.
Chapter 11 of the NHS plan of July 2000, on “Changes in the relationship between the NHS and the private sector”, said:
“The NHS is a huge organisation. Using extra capacity and extra investment from voluntary and private sector providers can benefit NHS patients… The time has now come for the NHS to engage more constructively with the private sector”.
Under the heading, “The basis for a new relationship”, it went on:
“Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients…By constructing the right partnerships the NHS can harness the capacity of private and voluntary providers to treat more NHS patients…Under our proposals a patient would remain an NHS patient even if they were being treated in the private sector. NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation.”
The right hon. Gentleman is outlining a thread of continuity very well. Is it not strange that the principal adviser to Alan Milburn has now been appointed by this Government as the head of NHS England? Does that not show that there has been continuity from one Government to another with the same policies?
I would hope, with an organisation like the NHS, that it would not become a political football—that there would be considerable continuity.
The fact that the person now in post worked with a Labour Government on NHS proposals when they were in government is a strong point rather than a weak one.
The point I am making, which I shall develop, is that the Bill is completely unnecessary. I also want to make the point that all Opposition Members seem to wish to deny that there has been any involvement of the NHS with the private sector. It is important to remind the House of the fact that it was the Labour party, and a Labour Government, who introduced the private sector into the NHS, and the 2012 legislation in no way significantly changed that relationship.
Does my right hon. Friend agree that those people who support the Bill would be supporting the removal of the cap on the amount of private income that hospitals can receive? Does he think that, when 38 Degrees was encouraging people to write in about the Bill, it made that clear to the people who signed its petition?
My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.
The right hon. Gentleman has just made a comment that cannot go unchallenged. He claims that the relationship that this Government have with the private sector is the same as that of the previous Government. That is absolute rubbish. When his Government’s legislation went through, he said that doctors would decide. Doctors throughout the country are now saying that they are mandated to put services out to the open market under section 75 of the Health and Social Care Act 2012—his Government’s legislation. That was not the case under the previous Government. If this Government are just doing the same as the previous Government, why did they need a 300-page Bill to rewrite the legal basis of the national health service?
May I remind the right hon. Gentleman of a document published on
“Introduction. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government”— the last Labour Government—
“has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.
The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.”
And it carries on. The document is headed, by the last Labour Government, “Socialist Health Association…A Concordat with the Private and Voluntary Health Care…Sector”. Indeed, the last Labour Secretary of State for Health signed a concordat with the Independent Healthcare Association on
The decision to make greater use of private sector facilities for NHS patients did not require new legislation and it was possible to undertake it within the existing legislation on the NHS, but for the avoidance of doubt let me quote the Labour party manifesto from 2001. In the chapter on NHS reform, Labour promised to
“work with the private sector to use spare capacity, where it makes sense, for NHS patients” and to
“create a new type of hospital—specially built surgical units, managed by the NHS or the private sector—to guarantee shorter waiting times”.
In my constituency, we have an independent orthopaedic treatment centre run by the private sector and introduced under the Labour Government. We have a Darzi walk-in centre run by private GPs, which was also introduced during the time of the Labour Government.
I thank the right hon. Gentleman for giving way in his long diatribe. He quotes the 2001 Labour manifesto, but it also said that any relationship with the private sector would not be at the expense of the terms and conditions of the staff working in the private sector who were transferred out. Today, Care UK people who work in Doncaster are facing a 40% cut in their take-home pay. Does he not see that that is one of the consequences of the Health and Social Care Act 2012?
With respect, I think the hon. Gentleman is seeking to avoid the point, which is that the 2012 Act did not fundamentally change the situation in the NHS between the public and private sectors. I draw the House’s attention to a debate that took place in Westminster Hall in 2002 on the subject of the private sector in the NHS that was initiated by the then Chair of the Select Committee on Health, the then Member for Wakefield, David Hinchliffe. The Minister, John Hutton, made a speech in response that could easily have been made in identical terms by the Under-Secretary of State for Health, my hon. Friend Dr Poulter. John Hutton said:
“I do not want to repeat arguments that have already been made about the future of our relationship with the private sector, but I shall deal with some more specific points. My hon. Friend the Member for Wakefield was concerned about whether reference costs provide a sufficient measure of value for money in the NHS. We accept that they do not, and we have tried to set out in our report several ways in which we can strengthen reference cost data.”
He went on to say:
“My hon. Friend also referred to the evidence that my right hon. Friend the Secretary of State gave to the Committee. He set out four essential tests that we apply to each prospective partnership in the NHS and private sector. Is it in the interests of patients? Is it consistent with the local and national strategies of the NHS? Is it value for money? Is it consistent with public sector values, including that treatment is determined by clinical need and staff are treated fairly? Those are the yardsticks by which we will judge and develop our relationship with the private sector. Provided that those tests are satisfied, we should use the private and voluntary sector where it has a track record of achievement or where it can offer clear potential gains.”—[Hansard, 11 July 2002; Vol. 388, c. 354WH.]
I have absolutely no doubt that those are views that my hon. Friend the Minister would endorse today. It is an entirely sensible approach to how the NHS and the private and independent sector should work. The National Health Service Bill passed during the Session of 2005-06 further enshrined the relationship between the national health service and the private sector in statute.
The Bill promoted by the hon. Member for Eltham misses the point. The Health and Social Care Act did not and does not introduce competition into the NHS, it does not change the rules on when to tender competitively and there is no requirement to tender all services. What it does do is manage the competition that has been introduced.
If the Act did not introduce competition to the NHS, will the right hon. Gentleman explain the following? Bristol hospital wanted to restructure its head and neck cancer surgery service. Monitor considered the proposal and concluded that it was likely to improve the quality of service to patients, butthat
In effect, it said that the restructuring could have improved the quality of care, but that because it would have removed competition, it could not go ahead.
The hon. Gentleman misunderstands my point. The Act did not introduce competition into the NHS because that competition had already been introduced by the previous Labour Government, who introduced greater private sector involvement in the NHS. Labour made binding rules to manage the competition, and the Act continued that approach with an expert health sector regulator working in the best interests of patients. Removing Monitor as the health sector regulator would merely leave commissioners facing actions through the courts under Labour’s own 2006 procurement regulations, which I do not think would be in the best interests of patients.
I am afraid that the right hon. Gentleman has undermined his entire speech with the ignorance he has displayed in response to my hon. Friend Clive Efford. For the first time in the history of the NHS, the Act gave a role to the competition authorities, under the Enterprise Act 2002, in taking precisely the kind of action that my hon. Friend referred to. I am very surprised the right hon. Gentleman does not know that; may I suggest that he does not know what he is talking about?
We heard that argument during the passage of the Act, and it is simply wrong. It is wrong to suggest that somehow the Act opened the door to competition.
I wonder if my right hon. Friend shares my consternation at the shadow Secretary of State’s remarks, given that throughout the 2000s, all we heard from Labour, John Hutton and the other Ministers he has mentioned was the importance of value for money and tendering for things. They are going back to the days of Frank Dobson being in charge.
My hon. and learned Friend makes a very good point. There is confusion about whether we have got new Labour or old Labour. The Labour party has to set out how it would undo the market it created without further top-down reorganisation. It could not do it simply by removing the health rules that manage it. There has been no change on when to tender competitively; the rules on procurement are the same as those used by the previous Government. The Act makes it clear that the Secretary of State remains politically accountable to the NHS. The changes in the Bill would restrict the greater autonomy given to the NHS and inhibit staff from making the innovative changes needed to secure sustainable, high-quality care for patients. In particular, it would tie the hands of clinical leaders on CCGs, which the NHS England five-year forward view says should have more powers, not fewer.
The right hon. Gentleman is engaging in a lengthy filibuster, in my opinion. I served on the Committee for the 2012 Act, and a plethora of organisations pointed out during the passage of that Bill the folly of what the Government were doing. They introduced a lengthy Bill; we spent 40 sittings in Committee; they tabled more than 1,000 amendments to their own Bill; it had 20 different sections; part 3 introduced Monitor. To suggest to the House that that Act introduced no change to the system operated under Labour is—well, it is not disingenuous, but it is not correct. I am not sure what term is best to use.
During the passage of that Bill, the Labour party and certain organisations, including some trade unions, sought to rewrite history. Interestingly, when Labour introduced things such as the independent treatment centres, the Darzi centres and the 2002 concordat, the trade unions that rallied to support the hon. Gentleman in Committee were totally silent. I do not think it lies in the mouth of those organisations, which did not complain when the Labour party introduced a partnership and a concordat with the independent and voluntary sector when it was in government, now to complain, simply because it is the Conservative party in a coalition Government, that we are somehow “privatising” the NHS. It is simply not true.
I have given way to the hon. Gentleman once, and as Grahame M. Morris accused me, ungallantly and unfairly, of filibustering—even though everything I have said is relevant and to the point—I would like now to make a little more progress and come to my final point, or almost my final point.
Order. It is not possible for the right hon. Gentleman to filibuster, because if he was not in order, I would not allow him to continue speaking.
I know that; you know that, Madam Deputy Speaker; I just wanted to make quite sure that the hon. Gentlemen below the Gangway knew that I was speaking relevantly.
I want to say something about the transatlantic trade and investment partnership. This is another of those things that people run around saying will be the end of civilisation as we know it. The transatlantic trade and investment partnership will not change the fact that it is up to the UK Government alone to decide how UK public services, including the NHS, are run. Any assertion that TTIP will undermine the NHS is a complete red herring. The position has been confirmed by both the European and the US negotiators, and indeed the chair of the all-party group on European Union-United States trade and investment. Excluding health from the agreement would prevent our pharmaceutical and medical devices sectors from benefitting from TTIP.
As we approach the next general election, I hope the Labour party will not treat the NHS as a political football. I hope we will not see, as we have at every general election since I have been an adult, the Labour party running around saying that it has 24 hours to save the NHS or that the Conservative party is seeking to privatise it, which is completely and utterly untrue. We all have a collective interest in ensuring that our NHS continues to be the best health care service in the world. There are huge challenges ahead for health care in this country, with an ageing population and ever-increasing improvements in medical technology. We should be facing up to those changes in an adult and responsible way. The Labour party should not be reneging on the clear commitments it made in both legislation and policy when it was in government. This Bill is totally unnecessary and it should not pass.
It is a pleasure to follow Sir Tony Baldry. He made an attempt to make a serious speech, but his 30 minutes were based on one argument that is fundamentally wrong, which is that this Government have made no changes to the basis of the NHS in this country. These 457 pages of his Government’s legislation show that that is wrong. If he looks at sections 72, 73 and 80 of the Health and Social Care Act 2012, he will see that the Competition Act 1998, the Enterprise Act 2002 and the Office of Fair Trading are brought into play for the first time in our NHS.
So why no Tory apology to NHS staff, patients and the public? Why no Tory apology to NHS staff for forcing through the largest internal reorganisation in 65 years of NHS history and for forcing them to cope with increasing confusion, complex bureaucracy and wasted cost? Why no Tory apology to the public for an NHS that they now see has longer waiting lists and service cuts? Why no Tory apology to the public for breaking election promises and the terms of the coalition agreement to stop top-down reorganisations of the NHS, which have often got in the way of patient care? Finally, while we are at it, why no apology to this House for the way we were misled about the reorganisation and the legislation in 2010 and 2011, which became the 457-page Health and Social Care Act 2012?
I will tell the right hon. Gentleman why there has been no apology: because there is nothing to apologise for. That is the simple reason. We have a better health service now than we had before; that is why there has been no apology.
Patients say exactly the opposite of what the hon. Gentleman has just argued. However, I understand that he feels he has nothing to apologise for. If he fundamentally believes that the NHS should be a system based on full-blown competition, delivered by the private sector, then of course he would want to legislate in that way.
While the right hon. Gentleman is going back to fighting some 1980s ideological warfare, I think most constituents are bothered about what happens in practice. Is he really asking me to apologise to my constituents for the fact that there are now 9% more professionally qualified clinical staff at Bradford teaching hospital and 42% fewer senior managers, or that there are 7% more professionally qualified clinical staff at Airedale NHS Foundation Trust and 14% fewer managers, or, I might add, for the brand spanking new, state-of-the-art A and E department at Airedale hospital? Does he really think that is something to apologise for?
The hon. Gentleman normally finds a common touch in the way he makes his points. I have to tell him that if he tries to trot out those sorts of figures on the doorstep in the next five months, he will find that they cut no ice with the public, because they know what is happening to their NHS day to day, and we will make sure they understand why it is happening.
Why should I apologise for the £150 million of investment in Lister hospital in Stevenage or the £98 million in Addenbrooke’s hospital in Cambridge—fantastic, world-beating facilities?
We on the Labour Benches cannot wait for the debate on the NHS to be put right at the heart of the next five months of policy and political debate, and my right hon. Friend the shadow Secretary of State will make sure that happens.
Let me return to my point about the way that we in this House were misled about the reorganisation and the legislation. I am disappointed to see that the man who led it, Mr Lansley, is not in the Chamber today to explain himself. He argued—it was completely wrong, but he argued it—in the debate on Second Reading in January 2011:
“It is about gearing the entire system towards supporting the relationship between doctor and patient”.—[Hansard, 31 January 2011; Vol. 522, c. 617.]
“The reorganisation and legislation is designed to break up the NHS, to open up all areas of the NHS to private health companies, to remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law.”—[Hansard, 16 March 2011; Vol. 525, c. 378.]
The Government were and are driving free market political ideology through the heart of our NHS.
The arguments that those of us on the Opposition Benches made then are those that we make now, and that my right hon. Friend Andy Burnham makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend Clive Efford has introduced is so essential and why I am so pleased and proud to be one of his sponsors.
My right hon. Friend made some powerful points when the Health and Social Care Act 2012 was going through Parliament, when Tory Members were denying the purpose of the legislation. He quoted the last Health Secretary, but the current Health Secretary, Mr Hunt, said in a book:
“Our ambition should be to break down the barriers between private and public health provision, in effect denationalising the provision of healthcare in Britain”.
What could be a more succinct and clear expression of their intentions?
My hon. Friend has been a strong champion of the NHS and followed this issue from day one of this Parliament. To answer directly his question of what could be more succinct and clear, I suspect that when we hear from Mark Reckless or his colleague, Douglas Carswell—given some of the things that they have argued should be the basis of the NHS in future—they will make the vision of the right hon. Member for South West Surrey look positively UKIP-lite.
This Bill is essential because it starts to correct the three fundamental flaws, brought about by the reorganisation legislation, that are now driving the NHS. We could call them the three Cs—cost, complexity and competition.
On cost, the scale of the reorganisation was simply huge. As the chief executive of the NHS said at the time, it was
“beyond anything that anybody from the public or private sector has witnessed”.
The cost of the waste has been huge. We reckoned beforehand that it was about £2 billion; we now reckon £3 billion. What is clear is that getting on for £1 billion has been paid out in redundancies, much of which was to staff who were paid off and then re-hired by our NHS.
I did not want to open up all the old arguments that we fought in 2010-2011, though it was extraordinary to see the extreme lengths to which the Government went—seen before only on matters of military information—to stop the disclosure of the risk register about the potential impact and likely consequences of their policy. My hon. Friend was a great supporter of mine in trying to get the Freedom of Information Act to allow the public and this House to see the terms of what the Government knew could happen to the NHS if they passed the legislation.
My second C is complexity. NHS services are now so much harder to plan and so much harder to hold to account because of the changes the Government have made. We saw new national quangos responsible for tens of billions of pounds of spending of public money in each and every one of our local areas in England. The commissioning role, which was previously undertaken by one body, the primary care trust, is now fragmented with at least five different bodies trying to do the same job.
On the third C, competition, the Secretary of State has his foot lightly on the accelerator of privatisation for now, but let us make no mistake, if the Tories win the next election, he will press it hard down to the floor immediately afterwards. Even though they are soft-pedalling on the privatisation that their Act put in place, we have seen in the 18 months since it came into force 131 contracts won by companies such as Care UK, Virgin Care and BUPA. According to the NHS Support Federation, that is already valued at £2.6 billion. At that win rate, the contracts already currently advertised will mean another £6.6 billion in the private sector—getting on for 10% of our NHS run by private companies in private hands.
It comes as no surprise, and I am grateful to my hon. Friend for underlining that point. I was not planning to make that point, but I am glad that it has been made so clearly.
My argument is with the Prime Minister. So much for what he said, and so much for his word when he said back in 2011 that
“we will not be selling off the NHS”.
Perhaps the most serious consequence of this fragmentation, this privatisation and this contractualisation is the fact that the most important and fundamental value at the heart of the NHS—an imperative at its heart—is the ability properly to plan, co-ordinate and deliver services. That is being made much harder, as the Health Select Committee has said, and sometimes impossible by the operation of the Health and Social Care Act and competition law. If anybody doubts it, they should look at the case of the two NHS trusts—the Royal Bournemouth and the Poole NHS Trusts—whose merger made great sense to patients, but was prevented by this Government’s legislation.
Let me say a few words about the transatlantic trade and investment partnership. I have chaired the all-party group that has followed these negotiations for the last 18 months in order to try to encourage a better and more balanced public and parliamentary understanding and debate, as well as to put the Government on the spot and hold them to account for what they are doing. We are trying to ensure that if we get a deal, it will bring real benefits not just to British business, but to British workers and British consumers.
Two things have become clear. First, the NHS can be fully protected in TTIP. I am convinced of this, not just because other EU trade agreements have protected public services, but because if the Government want them, there are specific member state reservations to cover public services and because we have heard the confirmation, directly from the chief negotiator whom I have met twice about this, that even with ISDS—investor-state dispute settlement—provisions, which I do not support, nothing could prevent a future Labour Government from bringing parts of the NHS now in private hands back into public hands.
The second thing that has become clear is that these commitments have been secured despite, not because of, Government Ministers. It is clear that Ministers have done next to nothing to try to influence the negotiations and secure the full exclusion and protection we require for our NHS and wider public services. Indeed, rather as Sir Tony Baldry observed, the Minister for Trade and Investment, Lord Livingston, who is responsible in government for leading the British position, has said that he would welcome the inclusion of health services in any deal. When the Minister gets up to speak, perhaps he will—formally, in this House—make the Government’s position clear. What is clear is that if we are properly to protect our NHS in any future TTIP, we must have a strong British voice in Brussels, which we do not have at the moment.
I gave the Prime Minister an opportunity on Monday to say that he would take specific action to ensure that the NHS would be protected if TTIP were successfully negotiated. He did not do so, but does my right hon. Friend feel that this debate provides an opportunity for that to be done in his name?
I would expect these trade negotiations to stretch into at least the end of next year, so I hope and expect that the responsibility for making sure that this deal is good for Britain will become that of a Labour, not a Tory, Government and of Labour Ministers, not Tory Ministers.
I am grateful to the right hon. Gentleman for making a very important point about TTIP. I know that the Scottish Government want the Scottish health service excluded and I would hope that the Welsh Government would have the same position. Is there not an onus on the UK Government to make those representations on behalf of the devolved Governments?
Indeed. There is an onus, a responsibility and, I would argue, a duty on British Ministers to make those representations and to secure those protections in any deal for the whole of the UK.
Finally, the Prime Minister made his most personal pledges before the last election to protect the NHS and to stop top-down reorganisations. He has broken those pledges to the British people, and the damage that he and his Tory Ministers have inflicted through this NHS reorganisation and legislation has been unwanted, wasteful and wrong. It will fall to a Labour Government, after May, to put right this damage and to rescue the NHS, as my hon. Friend the Member for Eltham said in his opening speech, just as we did in 1997. This Bill—it is why I am pleased and proud to support it—is an essential step towards doing that, but the election of a Labour Government must follow if we are to do the job properly.
It is a pleasure to follow John Healey, and I agree with most of what he said, but probably not the conclusion.
It gives me pleasure that we are having this debate. I think we all accept that the Bill will not go right the way through Parliament and end up on the statute book by 2015. We know what will happen: private Members’ Bills are lining up behind one another, and most of them will hit the buffers. However, the Bill moves the NHS debate up a notch.
It is fashionable at the moment to regard the Health and Social Care Act 2012 as a disastrous mistake. In fact, I believe that view is now shared in the Treasury. I did not support the Act, and not for the usual reasons—that it was not in the manifesto or the coalition agreement and was sprung upon Parliament. Those were good reasons, but they were not my main reason, nor was it because I am awkward or I thought it was a good career move. It was not because I did not see some of the upside, which I am sure the Minister will rehearse later—the emphasis on public health, clinical involvement, health inequality and mental health, and a smidgen of democratic accountability.
My main reason for opposing the Lansley Bill was that I saw it as the logical conclusion of a trend that began under Mrs Thatcher, was carried on by Blair and survives to this day. That trend, fundamentally, is an attempt to run the NHS as a market—not a real market, of course, but an internal market; a funny sort of Alice in Wonderland market with none of the advantages of a real market and most of the downside. It is one where everything is free, but prices, wages and policies are set by the Government; where NHS bodies compete not just against the private sector but against one another; where, as others have said, integration and real efficiency often go out of the window; where strategic leadership just does not seem to exist, as the right hon. Member for
Wentworth and Dearne said; where we struggle to deliver not products, as in ordinary markets, but entitlements; and where half the NHS, which we call commissioners, is billing the other half, which we call producers—that point has already been made—and bean-counters proliferate on either side and lock horns over bills.
In my view, the Health and Social Care Act was not so much about privatisation, or private industry helping to deliver NHS services—that was already happening under Labour—but primarily about marketisation. Some of course, see that as a conspiracy—marketisation as the prelude to total privatisation—but I have to tell hon. Members that marketisation as a faith is still very much around, including on the Front Benches of most political parties, and is supported by practically every health think-tank we talk to.
The market, external or internal, tweak it as we may, simply cannot deliver entitlements and the moral objectives of the NHS in anything like an efficient manner. It cannot deliver to people the care that they need regardless of their means. Worse still, it solves none of the current problems of the NHS, which were largely parked in 2010—the financial pressures on the acute sector, which have come back to haunt us recently; the poor integration of services, which we have still not got right; and the separation of health and social care, which is unfinished business.
If I have a proposal to put to the House, it is that I would like to see the commissioner-provider split ended. That has been mentioned already. We moved an amendment at the Liberal Democrat conference to try to see whether and how that could be permitted. I would like to see the creation of local health boards, charged with integrating services and running them efficiently.
The amendment my hon. Friend is talking about was proposed by Cambridge Liberal Democrats, and I pay particular tribute to Councillor Kilian Bourke, who chairs the health committee in Cambridgeshire. It suggested allowing NHS commissioners and providers in a local area to form an integrated health organisation if that was what they wanted to do. Does my hon. Friend agree that that would achieve the benefits that he and I seek without the need to force through a massive top-down reorganisation? Would he urge Clive Efford to accept such an amendment if the Bill made progress?
If the hon. Member for Eltham wished to talk about that, we could happily move away from the internal market where local circumstances required and demanded it. That would be an entirely sensible policy. I see no reason, though, why health boards should not procure goods and services based on simple best-value principles without all the competition legislation that has been vilified in the debate. They should be funded—as most services are—by capitation and according to local need, and they should be in some way democratically accountable, and I think we can get a genuine public service element back into the NHS. However, not every political party is advocating that at the moment, and some are steering in quite the opposite direction.
The hon. Gentleman is making a thoughtful speech, as is typical of him. Does he agree that what we are dealing with today is an Opposition party in desperate straits that knows exactly what it is doing in using the word “privatisation”? It knows that people out in the country associate it with having to buy private health care, but actually nobody is proposing to change the fundamental ethos of the NHS, which is that treatment is free at the point of need. The Labour party is conflating the two as a desperate political tactic.
The hon. Gentleman is not altogether wrong, but if we are to continue to deliver, in stressed circumstances, a service that is free at the point of need, we cannot run the NHS as an internal market for ever. In fact, the NHS is already trying to morph into something different. We now have health and wellbeing boards, which mean that commissioners and providers get together to try to agree a local plan. They are struggling in every way to behave like a health board, but they do not have the executive powers to do so. There has been the move away from tariffs, which have been used to try to adjust the market, and we are now talking about whole-treatment costs. There is also talk about integration.
What is clearly entirely disruptive, though, is the intrusion of competition where it is not needed—where it is simply dogma; where it is seen as a panacea for producing good results, whether or not there is a good case for saying that; where it derails sustainable services; or where it becomes a central operating principle of the NHS. None of those things is particularly helpful.
I do not want to comment on TTIP, because I do not think it is well understood at the moment, but we will certainly need to look at how it plays into the competition agenda.
If the hon. Gentleman or any other Members want to know a little bit more about TTIP, particularly the potential impact on the NHS and public services, we have a meeting of the all-party group on European Union-United States trade and investment at 2 o’clock on Monday, at which the EU chief negotiator will be on the panel alongside Dave Prentis, general secretary of Unison. The hon. Gentleman might like to come along.
If the right hon. Gentleman reminds me, I will endeavour to do so. What I am really hoping for, though, is a change in the conversation about the NHS so that we stop talking about the internal market—Labour Front Benchers have in a sense reneged on their involvement in that—and instead talk about how we should organise NHS services that will efficiently deliver the moral entitlements that people expect.
I am grateful to my hon. Friend for giving way and to Clive Efford for introducing this opportune Bill.
Does my hon. Friend agree that one problem with an internal market is the sheer complexity of tendering, which means that smaller organisations such as some in my constituency are simply not capable of matching up with the organisations that decide to tender for some of the contracts that are available?
My hon. Friend makes a good point. For those who are unsure about the benefits of the internal market, there is a way of addressing the problem, which is to allow individual health economies, in whatever area—Eltham or wherever—to opt out of the internal market if they can prove that there is a case for doing so. That could be put into legislation in a permissive form, so it would not be a top-down reorganisation, and it would allow people objectively and sensibly to test the benefits of the internal market against a more normal model of public service delivery, which I support, as I hope the hon. Member for Eltham does.
Indeed, I am proud, and many people in my constituency have moved down from Eltham and the surrounding areas, and I am delighted that they returned me to the House in the early hours of this morning.
I found the hon. Gentleman’s speech compelling. At half-past 4 this morning or thereabouts, I was extolling the virtues of the Levellers and the Chartists. I can only think that I had a premonition of the speech that the hon. Gentleman was to make in the House this morning.
The other reason for my presence here is that, in the by-election I have just fought, we had in Naushabah Khan a Labour candidate who made—quite eloquently, I thought —the case against fragmentation and privatisation of the NHS, and she and others in Medway Labour commended the Bill to me.
I was not in Rochester last night. I joined a vigil outside Parliament by groups who are campaigning to save our NHS, and I had a conversation with a consultant oncologist on that very issue of fragmentation. He said that the only competition we should have in the NHS is the competition to defeat disease. Does the hon. Gentleman agree with that?
That sounds a good statement. I myself feel a certain degree of scepticism, as John Pugh said, about internal markets in the NHS and other public services. Much depends on the circumstances of the service provided, and an ideological predisposition either against or in favour of internal markets is probably not wise.
The Labour candidate in the by-election opposed fragmentation and privatisation of the NHS, and the Bill appears to do so as well. I have discovered that this is now the Labour party’s position. I had assumed that the Labour party was in favour of fragmentation and privatisation in the NHS, because that was my understanding of what the record had been.
Perhaps the hon. Gentleman would like to clarify, for the benefit of the House, whether his party is in favour of a private insurance-backed approach to health care or whether it actually believes in the NHS.
My party believes in the NHS as a service that is free at the point of delivery. My father is a doctor, and my mother is a nurse. That belief is core to my values, and to the values of my party. [Interruption.] That is our policy. Our policy is determined by our party, and it is to support an NHS that is free at the point of delivery.
I think that the hon. Gentleman may be referring to the answer to a question that was asked two years ago, which is now being taken out of context. Our party is not quite like the Liberal Democrats with their federal policy executive, but we have formal measures for the making of policy, and UKIP has decided—
Although I do not agree with the hon. Gentleman on many things, I welcome him back to the House. He has talked about the history and the evidence. He might be interested to know that, according to the House of Commons Library, the amount spent by NHS England on buying health care from outside the NHS rose from £1.1 billion in 1997-98 to £7.5 billion in 2009-10. Those are the facts, according to the Library.
The hon. Gentleman is correct. There was a great deal of privatisation and, indeed, fragmentation of the NHS under Labour, and I do not deny that there has been more of it under the current Government. I think that it is a problem that has afflicted both main parties.
I will continue for a bit, if I may.
Let me explain how I view the issue from a local perspective. As far as I can see, Darent Valley hospital, which is in my constituency, was privatised under Labour in one of the most disastrous private finance initiatives experienced by the NHS. Medway NHS Foundation Trust became a foundation trust on the basis of what was largely a box-ticking exercise, which focused on finances and appeared to ignore the fact that by that stage the hospital’s standardised mortality rate was some 10% above the norm: one in 10 more patients were dying that should have been expected.
I will clarify the view of my party on the NHS in general, but I am afraid that I am not yet in a position to give details of its policy on the NHS in Scotland. I should be happy to seek to assist the hon. Gentleman on another occasion.
What happened in Medway was fragmentation. The hospital was cut loose by the Department of Health, and is now essentially run by an independent board. When there are problems and it is in special measures, there is now a potential for greater intervention, but we have in Monitor what appears to be a backstop regulator, rather than a regulator that is able to come in and run the hospital and turn it around. It can get rid of the chair and the chief executive, but it cannot make constructive improvements.
I will continue, if I may.
The independence of such hospitals, the inability of the House or the Secretary of State to drive improvements, and the decision to allow a hospital to become a foundation trust although one in 10 more people were dying than should have been the case, constitute an indictment of the last Government’s policy. I was delighted to hear from the Labour candidate whom I have faced in recent weeks that Labour is now against fragmentation and privatisation of the NHS. I welcome the Bill, and I am pleased to be able to support it.
I welcome support for my Bill from all quarters, but why should anyone believe what the hon. Gentleman says about the NHS? Does he accept that the Government were elected with no mandate to introduce the 2012 Act, and that he voted for it?
It might be helpful for the hon. Gentleman to bear in mind the words of his colleague, Douglas Carswell, who said:
“Never one to slavishly support the party line, I would be quite prepared to oppose these reforms”
—the 2012 Act—
“if I felt they were a step back. But I won’t. These changes are necessary—and contrary to much of the mainstream media coverage, in my experience they are quietly supported by many doctors too.”
Does the hon. Gentleman support what his colleague said, or does he not?
I think that my hon. Friend the Member for Clacton was right in saying that some doctors supported the Bill that became the 2012 Act. During the early stages of that Bill, a number of representative bodies supported it, or were presented as doing so. As the Bill proceeded, however, some of what had been claimed to be support from organisations such as the British Medical Association seemed to fall away. I believe that the Bill ran to 460 pages.
The problem was the way in which legislation is made in the House. The coalition agreement promised us a House Business Committee, but no such Committee deals with the allocation of time for legislation. We have a Committee of Selection, but it is run by the usual channels—the Whips on either side of the House—and people with expertise such as Dr Wollaston, who might actually have improved the Bill, were excluded from it.
I feel I should quote further from what was said by the hon. Member for Clacton, when much of the Committee stage of the Health and Social Care Bill had been completed. He went on to say—on
“If these proposals were defeated, it would be a setback for all those of us who would like to see public service reform. We need to keep our nerve.”
That rather contradicts what the hon. Gentleman has just said, does it not?
That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.
No, I will continue for a bit, if I may.
I do not think that the extent of the difficulties that doctors and others would encounter as a result of section 75 of the Act and the bureaucratic, market-based—or quasi-market-based—commissioning rules that it requires was any more apparent to my hon. Friend the Member for Clacton than it was to other Members, although some Opposition Members may have had premonitions of it. I thought that the Bill was intended to allow the various local bodies to get on with running the NHS in their areas. Some would run it better than others; there would be local decision-making and discretion, and people would learn from each other. Now, however, there are centrally determined rules that force everyone into, in particular, commissioning or contracting behaviour, but do not make sense in the context of the service that is being delivered.
I congratulate the hon. Gentleman on his victory in last night’s by-election. It was an excellent result for him and it would be churlish not to point that out. I know that he is a long-standing believer in localism. Is he not worried by the British Medical Association’s concerns that the Bill would give much wider powers to the Secretary of State, thereby centralising powers and taking the day-to-day running of the NHS away from clinical staff and putting it in the Secretary of State’s hands? As a champion of localism, is he not worried by that?
I am grateful to the hon. Gentleman for his congratulations; that is very decent of him. I am not a fan of quasi-autonomous bodies, of great amounts of regulators or of overlapping layers of bureaucracy; they rarely work. Given the degree of complexity that has now been brought into the NHS, I think it is possible—although I am not certain—that the centralisation of power in a single Secretary of State who is at least accountable to the House might be better than the current diffusion and fragmentation of powers, which does not seem to be working effectively. My party would like to replace the alphabet soup of regulators and the overlapping layers of bureaucracy with a single, elected health board for each county area. That would give a degree of clarity to the oversight and management of the NHS.
Why does the hon. Gentleman not think that health boards should be taken back into local authority control, where a democratic ticket is already involved, rather than creating a separate vote for stand-alone health boards?
There is an argument for doing that, and a judgment has to be made. It might be possible, depending on the different areas of the countries—particularly in the devolved Administrations—that the solution to that question might be different. My general view is that it is much better to have democratic accountability than not to have it, and in many areas I would prefer that to be local. My party wants to see health boards elected on a county basis.
My party also wants European competition law to be taken out of the NHS, and the Bill is exemplary in that regard. I strongly support that provision.
I have signed a pledge on TTIP, along with most other candidates in the by-election, except for the Conservative—[Interruption.] No, not the Liberal one—that was not a good one to sign—although I did vote against tuition fees, along with most Opposition Members. I would like to see the NHS excluded from TTIP. There are arguments as to whether it will be or not, but those arguments should be settled in the House as per this Bill, rather than being left to the unpredictability of future legal actions.
I am just reaching my conclusion, if I may.
The hon. Member for Eltham made a mistake in talking about the UK negotiating on TTIP. That is an area of exclusive competence for the European Community, and it is therefore the EU Commission that will negotiate with the United States on that matter. When I first heard about TTIP, it sounded as though it would be all about free trade and I thought that it would be broadly a good thing. The more I looked into it, however, the more it seemed to be not about free trade but about the creation of a single set of transnational regulations between the US and the European Union, and that it would be illegal for anyone not complying with them to sell goods and services. I am therefore very sceptical about TTIP and I am not sure it is something that I would want to support. I certainly do not want to see the NHS included in it.
I congratulate the hon. Member for Eltham on his Bill, and I look forward to supporting him in the Lobby.
I am grateful to be called to speak in the debate, Madam Deputy Speaker, and I apologise to my Front-Bench colleagues that I might not be here for the wind-ups because I have to be in Hinckley for the switching on of the Christmas lights, which is something I always look forward to.
I should like to follow a long tradition in the House in which the speaker who follows a Member making their maiden speech—even though I am told that, technically, it was not one—says something nice about them. I congratulate Mark Reckless on winning his by-election last night, and I further congratulate him on getting to the House this morning. I imagine that he has been up all night. I simply offer him this warning. I was thinking of Dave Nellist, a former Member for Coventry, who defected to another party and then disappeared. I have to warn the hon. Gentleman—my former hon. Friend—that the history of those who defect in this place shows that they do not remain here for very long after they come back. We expect to regain his seat at the next general election, but well done to him in the meantime.
I should also like to congratulate Clive Efford on introducing his Bill. I once had the honour to stand for the Greater London council in the constituency adjacent to his. It was then known as Woolwich East, so I know his area and his hospitals a little. He has certainly done well to get his Bill to the House, and I note from the Division this morning that he has 100 additional Members here today, so he is no doubt hoping for a closure motion at some point. If his Bill progresses, I would be happy to serve on its Committee. I have a long-standing interest in health matters and I have been a member of the Health Select Committee since it was set up in this Parliament, as well as of the Science and Technology Committee in this Parliament. I am also the chair of the all-party parliamentary group on integrated health care.
This is a wide-ranging Bill. I hope to address some of the things that are not in it, although I will not talk about all the things that are in it as time is short and I do not want to occupy the stage for too long. I want to look at three areas. The first is the hon. Gentleman’s proposal to change the arrangements that allow trusts to generate half their income from private sources. Secondly, I want to look at whether mergers should be dealt with by Monitor or whether that area should be reclaimed. I want to focus on mergers and integration, because the integration of services in the NHS is of fundamental importance. He might be able to improve his Bill in that respect. Thirdly, if time allows, I want to talk about the proposal to exempt the NHS from the transatlantic trade and investment partnership.
I have just been speaking to John Healey, and I believe that Labour’s whole strategy is based on something that is fundamentally untrue. It is based on trying to persuade the electorate that we are setting out to privatise the health service and thereby reduce the health care available. It is regrettable that Labour is taking the Goebbels-esque approach of saying something that is fundamentally untrue and then repeating it and repeating it in the hope that the electorate will buy into it. I put it to Labour
Members that that might be a populist approach, but it could be hard for them to defend as we get nearer the election.
The hon. Gentleman says that he does not believe creeping privatisation is taking place as a result of the changes that the Government have introduced, but does he not see it as an inevitable consequence, even if it is not the Government’s stated intention?
I thank the hon. Lady for her intervention. The Government have made it possible for trusts to generate half their income from private sources, but it is not true to make out that we are in some way privatising the health service in a way that is detrimental to patients. We have made it possible for trusts to generate more income. In an ideal world, it would be wonderful if we could pay for all health care through general taxation. However, the Health Committee has examined the Nicholson challenge and seen the tremendous demand on resources. We have managed to maintain a flat-line budget in this Parliament, but demand is such that it is difficult to pay for everything through general taxation. One way to do it is by getting the private sector to contribute to the health service. The original arrangements were increased to this figure of nearly half. The thing to remember is that all the money generated from these sources is reinvested in patient care.
I had some freedom of information requests made, and wish to refer to the effect of these arrangements on four NHS foundation trusts in the midlands. They are not from Leicestershire, because those figures did not come through, but I do represent a midlands constituency. The Dudley Group NHS Foundation Trust received £68,000 in 2010-11, £50,000 in 2011-12 and another £80,000 in 2012-13 in funds that can go directly into patient care. The figures for the Heart of England NHS Foundation Trust are £559,000 in 2009-10, another half a million in 2010-11, a bit more in 2011-12 and nearly £532,000 in 2012-13, and there has been an increase to £628,000 in 2013-14.
“The Shrewsbury and Telford Hospital NHS Trust gains substantial income from Apley Ward and Clinic. Where private patient work is carried out in an NHS hospital, it is carried out in addition to and not in place of regular NHS treatment. Profits from this private facility make a considerable contribution to the running costs of the hospital for the benefit of all patients and staff.”
The hon. Member for Eltham made a passionate speech, but this point goes to the heart of the issue: privatisation is not about reducing resources, but increasing them. I gave notice to Valerie Vaz that I was going to mention the other figures I received, which are from the Walsall Healthcare NHS Trust and which show that over the past four years it has gained between £14,000 and £50,000 a year. The figures illustrate clearly that this approach is helping, and that is very welcome.
The point my hon. Friend has just made is key in showing the dangers of this Bill. People have been writing to say that they are concerned about the risk of privatisation, but what is actually happening as a result of the 2012 Act process is that there is more money in our NHS, rather than less.
The Act is complicated. It is a big Act and it landed with a thump when John Healey dropped it on the Opposition Benches. I think he did so intentionally; and it was very theatrical and effective. It is true that there is more money there, and it is clear that the Government pledged at the last election to maintain the funding of the health service and have done so. We also have in place the Nicholson challenge, a phrase coined by my right hon. Friend Mr Dorrell—formerly the Member for Loughborough—when he was Chair of the Health Committee, and we now face even greater challenges.
Let me set out to the hon. Member for Eltham what he could include in his Bill if it goes forward. He could examine the next stage of bringing together health and social care. On Tuesday, the Health Committee heard from Dame Kate Barker, the chair of the Commission on the Future of Health and Social Care in England. We were examining the transitional costs of bringing health and social care together, and looking ahead at the savings that can be made. The hon. Gentleman might apply his mind to the complications arising from the different streams of funding represented in health and social care, whereby health is funded by general taxation and some private support, which I have already discussed, whereas social care is the subject of means tests and other constraints. We are therefore talking about completely different funding stream. I do not know how the Health Committee will report this, but I was struck by Dame Kate Barker’s determination that there should be one person running health and social care. That is essential if we are going to bring those two things together.
The other point the hon. Gentleman should take on board as we look at the Bill is the high profile that the Secretary of State and his predecessor, my right hon. Friend Mr Lansley, have given to patient choice. The Government have said time and again that patient choice is at the heart of the health service, and we have already seen the benefits. The personal budgets now available for people who are seriously ill have had three benefits. First, they enable the patient to choose whatever treatment they want, be it tai chi, yoga or piano therapy—I believe that there have even been cases where tickets to a football match have been given. This is not something regulated by double-blind placebo controlled trials, as some of the other access arrangements for health care are. Secondly, the personal budgets enable the carers to go out into the world and get jobs, so freeing them up. Thirdly, when the personal budget money is given, it is spent responsibly by the patients. We have a whole new paradigm of health through personal budgets, and that should be examined through this Bill.
I have always felt that the 2012 Act and the reforms that were made produced something that put in place two legs on the stool, not three. The third leg comprises the vast and diverse multiplicity of support services that are not used in great depth in the health service now. Using them would considerably reduce costs and increase choice. The choice of these other support services will inevitably come to the fore as patients demand what they want, and we really have to bring this into the health service.
I have had many conversations about these things with the Under-Secretary of State for Health, my hon. Friend Dr Poulter—the Minister on the Front-Bench today. He has entrusted me with being vice-chair of the herbal working group, which is trying to sort out herbal medicine regulation. When we examine the support services that are not now part of mainstream health care, we see that we have a fundamental problem relating to the insistence that we rely on evidence-based medicine. I do not know where that phrase came from—it has not been around for a long time. Various bodies protect the public, and all new drugs are carefully scrutinised, by the pharmacists and the Herbal Medicines Advisory Committee, which has put together a list of what are, in effect, poisons and bans the use of some herbs. The public are protected in that way, but it is very difficult to use normal measurements to assess the effectiveness of, for example, acupuncture, which the National Institute for Health and Care Excellence has approved for treating lower back pain. A lot of evidence shows that acupuncture can reduce the effects of lower back pain and save the NHS a lot of cost. With homeopathic medicine, which I have long supported and advocated, it is impossible to run trials on every dilution: some are so dilute that they do not show up.
My hon. Friend will be well aware that there have been many trials of homeopathic medicines, and the fact is that none of them has shown that they work better than a placebo. He is right that they are very dilute; that is why they do not work.
The hon. Gentleman makes my point. I remember when some of his friends went to Boots in Kensington high street and consumed the entire stock of homeopathic medicine. They saw that as a huge triumph, as they felt it illustrated the fact that homeopathic medicine was not effective. Of course it did nothing of the sort; it proved that it was absolutely safe to take these preparations under any circumstances, and that the only time they work is if they are in the right preparation and are taken in the right amount, as prescribed by a professional.
I say to the Minister—I hope he will tune in to what I am saying—that we must move away from this insistence on evidence-based medicine and look at evidence-based practitioners. This is an area that has been overlooked for a very long time. There is much evidence that practitioners are well regulated, and we do not need to insist on checking every single preparation that people consume. Five areas of regulation already exist. The hon. Member for Eltham might want to think about that, as it is a matter that could be put into the Bill if it goes to Committee.
Order. The hon. Gentleman is aware that I am watching very carefully the matters that he is addressing in the House right now. He must speak to the Bill. We are discussing whether the Bill should have a Second Reading and go into Committee.
Madam Deputy Speaker, you are kind to draw that to my attention. I simply say this: there are different regulatory bodies—not just Monitor—that we should consider. We should be taking on board the fact that osteopaths, chiropractors, homeopaths and doctors are regulated by an Act of Parliament, yet the Health and Care Professions Council regulates clinical scientists, paramedics, physiotherapists. The Professional Standards Authority, which is another regulatory body, provides oversight of nine statutory bodies. Then there is the umbrella body, the Complementary and Natural Healthcare Council. I will leave it at that, as I do not wish to stray. On the safety aspects of those bodies, I understand from Balens, which has been insuring support services for 10 years, that there has not been a claim against a herbalist for more than 10 years.
The Bill partly addresses the issue of the transatlantic trade and investment partnership. Across the world, there is whole mass of new thinking that could be incorporated in our health service. I am nervous that if we take out TTIP—if an exemption for the NHS is proposed—it will not be in our interests. In America there are a lot of integrated practices, in which a range of different health disciplines are brought together to reduce costs.
We are agreed on that. It is a case of the extent to which we derogate the powers of the Secretary of State. We have a whole lot of new bodies, including clinical commissioning groups, which have been a great success.
I congratulate the hon. Member for Eltham on securing this slot today. I wonder whether he still has 100 troops in the Tea Room waiting to come in for a closure motion, if Madam Deputy Speaker is gracious enough to grant it. I am happy to serve with him in the future on his Bill.
Is my right hon. Friend aware of the unique deal between Northumbria Healthcare NHS Trust and the Labour-led Northumberland county council in which the council bought out the PFI deal, which means a better deal for the taxpayers in Northumberland and a much better deal for the NHS trust and the patients?
Yes, I am aware of the deal, and it is a great example of how a Labour council, working with the NHS, can take steps to improve funding for front-line patient care. It happened because of the deal that was struck in the latter stages of the previous Labour Government.
As a result of the Health and Social Care Act 2012, NHS hospitals can earn more money from treating private patients, while NHS waiting lists get longer. Those same hospitals have now been told by competition authorities that they cannot collaborate any more because it is “anti-competitive.” How did it come to this? That is not the health service that we have known for 66 years. Every day that this illegitimate legislation remains in force is a day closer to the demise of the national health service.
In response to an FOI request, I was told by my local health board that between December last year and July this year, 373 ophthalmology patients, 90 pain management patients, 165 neurology patients and 264 orthopaedic patients were transferred to private sector providers at a cost of nearly £600,000. What is the right hon. Gentleman’s message to his Labour colleague, the Health Minister for Wales?
I will give the hon. Gentleman my message now: the Labour Government in England and in Wales have taken steps to bring down NHS waiting lists. When we left office, they were at the lowest ever level. I make no apology to him for those improvements.
The 2012 Act has put the NHS in danger, which is why it has to go. Back on that March day in 2012, I pledged that the party that created the NHS would repeal that Bill at the first opportunity, and today we honour that promise. The Bill before us, presented by my hon. Friend Clive Efford, restores the right values at the heart of the NHS: collaboration over competition; integration over fragmentation; people before profits.
Will the right hon. Gentleman care to comment on the letter in TheDaily Telegraph today, signed by a number of doctors and led by the chairman of NHS Alliance, asking people not to support this Bill today, as it would be a backward step for patients?
I am sure that Tory central office has been ringing around for a few days trying to find some doctors who are still in favour of the legislation, and they found 11. Well, I think that is probably about the limit for the number of people prepared to put their name to it. I can tell the hon. Lady that thousands of doctors lined up with the Opposition and pleaded with her party to call off its reorganisation, and that included the British Medical Association and the royal colleges, but it would not listen. The Government ploughed on regardless, and the NHS has gone downhill ever since.
That is why my hon. Friend the Member for Eltham gave a stirring speech of the kind this House needs to hear more, full of conviction and passion, standing up for the national health service that he believes in. He has brought before the House a Bill that reaffirms the words of Nye Bevan’s original National Health Service Act 1946 on the democratic accountability of the NHS to the Secretary of State and, by extension, to this House. The Bill abolishes the compulsory tendering of NHS services and removes market forces. It reduces the private patient income cap back down to single figures. Once and for all, it fully exempts the NHS from EU procurement and competition law, as is our right under the Lisbon treaty. It sends the Government an uncompromising message that the NHS will never be touched by any TTIP treaty.
In particular, I commend my hon. Friend for saying that it is about time this House regained full sovereignty over the national health service. They gave it away—the Eurosceptics sitting there on the Government Back Benches—when they mandated open tendering of services. By doing that, they placed the NHS in the full glare of European competition law. [Interruption.] They do not like to hear it, but that is what they did.
Is the right hon. Gentleman the same man who used to talk about an end to the polarising debate on private and public sector provision? Is he the same man who, when Secretary of State, privatised the services for an entire hospital at Hinchingbrooke? What is he doing today? It is buff and blow party politics.
I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.
The right hon. Gentleman correctly says that the contract for Hinchingbrooke was let under this Government, but does he not accept that it was he who, when Health Secretary, reduced the list of bidders to five, none of which were NHS bidders, and then to three, all of which were private companies? Does he accept that he could have left NHS bidders in the process, rather than only private bidders? Then he complains when one of the providers that he shortlisted got the contract.
I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—
On a point of order, Madam Deputy Speaker. I may have inadvertently said that the contract was let, but I do not believe that I did. The true position is that it was the right hon. Gentleman who took the decision to privatise the services in that hospital, and it is wrong for him to seek to deny it.
Order. I appreciate that the hon. and learned Gentleman wishes to ensure that the record is set straight. He has attempted so to do, but it is not a point of order for me to deal with.
“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend Mr Lansley. He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.
I was in the middle of answering the intervention from Dr Huppert—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—
No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.
The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.
My right hon. Friend says that the Bill will mean so much to so many people. He will recall that in 1997 the waiting lists at Northwick Park hospital were the highest in the country, with people having to wait for 21 hours on trolleys. He will also know that the people in Brent and Harrow who rely on that hospital today are now enduring the highest waiting lists in the country again. Waiting lists came down on his watch, but they are back up again. What message does that send to the people of Brent and Harrow?
My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend Mr Skinner said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.
What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the
Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?
On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?
The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.
We have spineless Government MPs who will not come here today to argue for the Act.
I congratulate Mark Reckless on his victory and on being here today, despite being up all night—I cannot imagine that he managed to get any sleep. His party leader has said that when the hon. Gentleman is tired he says things that he does not mean—I think that he just nodded there. Given that he has been up all night, I can only conclude that he does not actually believe what he said in the speech we just heard. In three days he has gone from being in favour of the repatriation of European citizens to being against the privatisation of the NHS. That is a pretty big political distance to cover in just three days.
I have only ever argued for European citizens to be able to stay; any other words came from others, not me. It is the right hon. Gentleman’s party that has reversed its position, having previously privatised the Darent Valley hospital and fragmented the Medway Foundation Trust, but it now seems to have a better policy, which I am happy to support.
The hon. Gentleman said that he could not understand Labour’s position, but surely he remembers 2012, when Opposition Members spoke with force against that legislation, which he then voted for in the Lobby. I know that it has been a long night, but he really should try to remember these things, because they are quite important.
Is it not also true that the hon. Gentleman went through the Lobby not once, but 18 times, despite being told time and again that what has now happened would happen? The people who had their finger on the pulse were telling us what would happen, but he ignored them.
It is a tiring business being an MP and it is possible to forget things, particularly when one drinks as many pints as UKIP Members do, but they should try to remember. Their party leader once said that he would give the NHS budget to insurance companies; apparently, he does not believe that now. The deputy leader, a Mr Nuttall, said that the right hon. Member for South Cambridgeshire was to be congratulated on bringing a whiff—just a whiff—of privatisation to the NHS, and Douglas Carswell, whom the Minister quoted earlier, described the Lansley reforms as “fairly modest”. He chided his Tory colleagues who were sniping against him at the time and said that the reforms must not be derailed. The party says it is anti-politics in the way things are done. This is sheer opportunism and dishonesty.
I appreciate what the hon. Gentleman says—it would be churlish for me to say otherwise—and I am grateful for the way he said it. The things Opposition Members were saying back then have happened, and we can see the effects of the Government’s reorganisation in the NHS. With the new figures that came out this morning, we see that A and E has missed the Government’s target for 70 weeks in a row. The A and E figures are the barometer of the health and care system. They are the best place to look if we want to see whether there are problems in the health and care system. The fact that the target has been missed for 70 weeks in a row tells us that severe storms are building over the NHS.
I am glad my right hon. Friend raised that. It takes us back to pre-1997, when people who could not get beds were lying on trolleys. I am sure he remembers that. I can remember a hospital in Coventry that was falling down. As a result of the Labour Government, we got a new hospital.
My hon. Friend is right. The Labour Government inherited a situation where almost three quarters of the NHS estate was built before 1948. We transformed that, as well as bringing those waiting lists down. He is right to remind us.
I cannot believe that Government Members have not had the guts to be here today to argue for their own policy on the NHS. Or is it that under the shambolic regime of their new Chief Whip, who is now inflicting the same chaos on the parliamentary Conservative party as he did on England’s schools, the Government did not think they could win the vote today, so they did not dare to bring their troops here to hold it? I do not know what the reason is, but they clearly do not believe in their own legislation and the catastrophic reorganisation that followed. An unnamed senior Cabinet Minister has been quoted in The Times as admitting that it was their single biggest mistake.
It is one of the biggest scandals of recent times that people in this House who have links to private health, and many more in the other place, put through legislation that did not have a mandate from the British people and from which they would benefit financially. The story of that will one day be told in full.
The reorganisation has dragged the NHS down and left it on the brink. A reorganisation that was meant to put GPs at the heart of the NHS has left patients waiting days or even weeks to get a GP appointment. This week, there was news that the NHS has missed its cancer standard for the third quarter, leaving thousands of cancer patients waiting more than two months for treatment to start. It is a reorganisation that has systematically run down the NHS and opened the door for it to be sold off.
The reorganisation was unnecessary. My right hon. Friend is no doubt aware that in Staffordshire a £1 billion cancer contract has been put out to tender. The newly rebuilt local hospital is concerned that that will destabilise its finances. Does he agree that we should be very careful about going down that route without proper consideration?
The example that my hon. Friend quotes is the best example of the fact that the Government see no limit at all on the scale or extent of privatisation in the NHS, both in terms of the monetary value— £1 billion—and the fact that they are prepared to put cancer services out on the open market.
Does my right hon. Friend recall that some of us supported his opposition to the Health and Social Care Bill, which purported to be England-only legislation? By its marketisation and altering of the public service ethic for the health service, it was going to be predictive legislation with severe implications for devolved services. For similar reasons we support the Bill today, because it offers a bulwark against TTIP hazards for devolved health services.
Is my right hon. Friend aware that the companies on the list of preferred bidders to provide cancer care in north Staffordshire include CSC computer services, which was responsible for the £10 billion IT failure, the Lorenzo system, and Interserve Investments, which was fined £11 million by the Office of Fair Trading for anti-competitive bid rigging? These are the sort of firms that our cancer services might go to.
Those examples will alarm people. In Greater Manchester, a bus company has been running ambulance services. We had news this week that an arms manufacturer is bidding for a GP contract. These are the things that are beginning to happen to the NHS. Nobody’s constituents have ever given their permission for any of this to happen.
We heard speeches from David Tredinnick and Sir Tony Baldry, who said that nothing had changed and what was happening in the NHS now was just a continuation of what the previous Government were doing. No, it is not. The right hon. Member for South Cambridgeshire said in a speech on
“The time has come for pro-competitive reforms in…health” and he help up the example of utilities and rail. That was the specific inspiration for his reorganisation. He sold his Bill on the basis that doctors would decide, but doctors tell us that they have no choice but to put services out to the market. Section 75 says that commissioners may not run a tender only if there is one available provider. That is never the case, which is why CCG lawyers conclude that they have no choice but to put services out to tender.
That is why we see, according to figures from the NHS Support Federation, that 865 contracts for NHS services, worth £18.3 billion, have been offered to the market. Some 67% of the contracts awarded so far have gone outside the NHS. It is this decision to mandate the tendering of services which places the NHS in the full glare of EU procurement and competition law. Because Ministers have refused to exempt the NHS from the TTIP treaty, we could soon have private US health care providers ringing up CCGs to challenge them on their commissioning decisions.
This Bill legislates to remove that threat. It repeals section 75 and it really does let doctors and local commissioners decide. It restores the role of the Secretary of State and brings much needed ministerial accountability back to this House. No longer will Ministers be told to write to NHS England when they have concerns. Instead, there will be answers from the Government Dispatch Box about the service that matters most to their constituents. It removes the role of the competition authorities that the Government’s Act introduced. It stops the ludicrous situation where hospitals such as Bournemouth and Poole are not allowed to collaborate. Importantly, it stops hospitals devoting half their beds and half their facilities to the treatment of private patients.
Since Hammersmith and Central Middlesex A and E departments closed two months ago, we have had people waiting in ambulances and waiting rooms with every seat taken. We have even had people waiting on floors. The Government’s answer to that is to close two more A and E departments, those at Charing Cross and Ealing in west London. Is that not just preparing the NHS for failure and for privatisation?
What is happening in west London should send a shiver down the spine of every community in the country. The NHS is being torn apart, which is damaging patient care and leading to the consequences that my hon. Friend outlines.
This is how the character of the NHS is changing under this Government and before our eyes. With every year that the Health and Social Care Act stays on the statute book, the private sector will be more embedded in the NHS and the public NHS weakened as a result. The Government have undermined the “N” in NHS. They are letting our hospitals become part-privatised and they must be stopped. If the Government continue on their current course, in the next Parliament the NHS will be overwhelmed by a toxic mix of cuts and privatisation.
If the Government stop this Bill receiving Royal Assent, it will form the basis of the repeal Bill that the next Labour Government will lay before the House in May next year. But it will do more than that: it will remove the competition role to allow the full integration of health and care to build and lay the foundations for a 21st-century NHS.
One final thing needs to be said. Before we vote, there is a simple truth that all Members in all parts of the House must confront: nobody here has permission from their constituents to put the NHS up for sale. Today is their last chance to put that right before they face their constituents in six months’ time. The people of this country value and trust a public NHS that puts people before profits. This Bill restores that. The party that created the NHS is proud to support it, and I urge all Members to vote for it.
I shall begin by returning to the founding moment of our NHS, when a national health service was created which remains to this day a world-class health service where care is available to all, irrespective of ability to pay and free for all at the point of delivery. These fundamental principles of our NHS have been cherished and protected by each and every Government throughout its proud history, and were in 2012, for the first time, put on to statutory footing by this Government through the Health and Social Care Act.
If my hon. Friend will bear with me, I am going to make a little more progress and then give way later on.
Those who believe that our NHS has always been run solely through public providers are of course very wrong. From its very inception, the NHS that Nye Bevan created has comprised providers in the public and the non-public sectors. In 1948, independent GPs, community pharmacists and dental practitioners contracted with our health service to provide primary medical services to patients, and they continue to do so to this day as part of the public-private partnership. It is worth reflecting on the fact that Tony Blair’s former political secretary, John McTiernan, said only this August that
“an NHS without private providers is unimaginable. For one thing, no one—even on Labour’s extreme left—is arguing that we should nationalise general practice. But GPs are private providers, acceptable to opponents of the ‘private sector’ because most encounters with the NHS are visits to your local doctor.
In opening my contribution to this debate, I reaffirm this Government’s commitment to the founding principles of our NHS, a health service free at the point of delivery, and recognise that since its creation by Nye Bevan in 1948 our NHS has always been a public-private partnership. For public services to be equitable and free at the point of use, they did not all need to be provided on a monopoly basis within the public sector, controlled in a rigid way by local bureaucracies often deeply resistant to innovation and genuine local autonomy.
“The aim should be to change fundamentally the way the NHS was run: to break up the monolith; to introduce a new relationship with the private sector; to import concepts of choice and competition”.
Does my hon. Friend agree that the most damaging thing for the NHS—patients and staff alike—is a lot of misleading scaremongering? I am afraid that we have heard more of that in the Chamber today. Will he correct the record to make sure that it is very clear that the pledge made by the Secretary of State for Health that the A and Es at Ealing and Charing Cross hospitals will both remain open for the long term still stands, and that they will allow themselves to be directed by Bruce Keogh’s report such that whatever recommendations he makes on A and E, they will make sure that they meet those requirements?
I am happy to confirm and to put on the record the points that my hon. Friend has made. It is important that the NHS is not used as a political football, and that services are always designed and delivered in the right way for patients. There is often too much scaremongering in these debates. I reiterate that what she said about the local A and Es is absolutely correct.
I have just dealt with it, and I am going to make a little progress.
I want to deal with the contribution made by Mark Reckless. He failed to address the issues that I had raised earlier about the support that Douglas Carswell, his party colleague, gave to the Health and Social Bill—now the Health and Social Care Act. In fact, as Andy Burnham said, the hon. Member for Clacton thought that the reforms did not go far enough. Indeed, the leader of his party is on record as talking about the need, in effect, to privatise our NHS. I would like to reconfirm the commitment that that will absolutely never happen under this Government or any Conservative Government.
Another important point needs to be made. Earlier this week, the hon. Member for Rochester and Strood expressed frankly unacceptable and distasteful views on repatriation. We must of course bear in mind that 40% of staff in our NHS come from very diverse, multicultural backgrounds. We very much value the contribution that doctors, nurses and health care staff from all over the world make to our NHS. I do not want to see those people repatriated; I want to see them continuing to deliver high-quality care for patients in our NHS—something that UKIP clearly opposes.
I have made absolutely no such remarks; I have said only that we wanted such people to be able to stay. The disgraceful remarks were actually made by the Conservative candidate, who juxtaposed the issues of unlimited immigration and fear of crime.
I think that the hon. Gentleman’s remarks are very clearly on the record, and I am sure that NHS staff, many of whom come from very diverse, multicultural backgrounds, will be very aware of them. In this Conservative-led Government, we are very proud of the contribution that people from all over the world make to our NHS, and I believe that that needs to continue in the future. As we have seen from the hon. Gentleman’s leader, his party makes it up as it goes along on things to do with the NHS. It is in favour of privatisation and does not value the contribution—[Interruption.]
On a point of order, Madam Deputy Speaker. There is so much noise coming from the Opposition Bench below the Gangway that it is impossible even for someone who is as near to the Minister as me to hear what he is saying. Given that Labour Members appear to support this Bill, it would be a courtesy for them at least to listen to the Minister with some attention.
The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.
Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.
I think that the hon. Gentleman has said quite enough already, and I need to make some progress.
Let me move on to the second, substantive, point in this debate, on which I hope there will be a large amount of agreement. It was articulated—
There has been much discussion this morning about who has said what about what. My concern in the Chair is that the Bill should be discussed. That is the matter before the House, and we will discuss it.
Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.
As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.
That is a very important point that goes to the heart of this debate and that really needs to be cleared up for those listening and watching. The Minister said that the Act did not introduce competition. Will he confirm that it gave, for the first time, a role to the competition authorities under the Enterprise Act 2002 and that since then they have intervened, for the first time ever in the history of the NHS, in Bournemouth and Poole?
What I will confirm is that it is factually correct, as my right hon. Friend the Member for Banbury made clear, to say that it was the previous Labour Government—Tony Blair’s Government—who introduced competition into our NHS. At the end of Labour’s time in office, I believe that £6 billion a year was going to NHS providers. The right hon. Member for Leigh was quite happy to pay private sector providers 11% more than NHS providers for providing the same service. That was Labour’s commitment to the private sector, which we have cleared up and put right in the 2012 Act.
Let us remember what the Labour party said in its last general election manifesto. I am sure Labour Members will remember it well—the right hon. Gentleman may well have written it. It said:
“All hospitals will become Foundation Trusts…Foundation Trusts will be given the freedom to expand their provision…and community care, and to increase their private services”.
That is from the manifesto that every Labour Member stood on at the last election. The facts are clear: competition in our NHS was introduced well before this Parliament and well before this Government came into power. It was introduced by policies made by Members who now sit on the Opposition Benches—the policies of the previous Labour Government.
As my right hon. Friend the Member for Banbury reminded us, it was Labour that introduced the use of independent treatment centres in 2003, the “any willing provider” policy and the advent of patient choice in 2006, and it was Labour’s policies when in government that brought NHS commissioning under the scope of European competition law through the Public Contract Regulations 2006.
There is an interesting argument taking place between the two Front Benchers about who is responsible for bringing competition into the health service, but the fact is that, no matter who is responsible, the health service could now come under the transatlantic trade and investment partnership. Why will the Government not specifically exclude health services from TTIP before it is negotiated?
I will come on to TTIP later, and I hope I will be able to reassure the hon. Gentleman.
The previous Labour Government attempted to make commissioners compliant with the law by publishing the “Principles and rules for cooperation and competition” in 2007 and establishing the competition and co-operation panel in 2009, to oversee Labour’s NHS marketplace. Let us be clear: it was the previous Labour Government who chose to introduce private providers into our NHS and it was the previous Labour Government who set up the legal framework to support private providers in the health service.
It has been said that
“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.”—[Hansard, 15 May 2007; Vol. 460, c. 251WH.]
Once again, those are not my words, but those of the right hon. Member for Leigh when he was a Minister in the previous Government. That is a fitting memory of the previous Labour Government’s expansion of private providers in the NHS. Let us remind ourselves of the right hon. Gentleman’s words again: he said that most people in this country would celebrate the private sector in the NHS.
I am just a doctor who still works in the health service and I practise medicine for free. Of course, we could go into the fact that I am the only Front Bencher present who has front-line experience of looking after patients. Professional politicians on the Opposition Benches are outlining a case that is incoherent with their record in government. We could also talk about the huge union funding that goes towards many Labour policies, but time would forbid us from doing so and I am sure that the Deputy Speaker would not want me to digress from the subject of this debate.
Let us come on to what the Health and Social Care Act actually did. First, it stripped out an entire layer of management from what was at the time an overly bureaucratic NHS. This is an important point that hon. Members would do well to listen to. The reforms will save our NHS £5.5 billion in this Parliament alone, and £1.5 billion every following year. That money is being put back into front-line patient care. In addition, as I notified the House in an answer to a recent written question, spending on administration as a proportion of the total NHS budget has fallen under this Government from 4.3% in 2010-11 to 2.9% in 2013. More money is going into front-line patient care because we have stripped out bureaucracy and administration and freed up that money to look after patients.
Between 2010 and July 2014, the number of infrastructure and administration support staff in the NHS has reduced by 10.3%, which is about 21,000. That includes a 17.7% decrease in managers and senior managers combined. Savings from reducing bureaucracy in this manner are being ploughed back into front-line patient care. For instance, we now employ 8,000 more doctors and 5,600 more nurses on our wards than in May 2010, and our NHS can do nearly 1 million more operations every year.
The hon. Gentleman is taking us through a very detailed list of bureaucratic costs. Obviously, the Government are paying close attention to that, but why is it that when I asked them about the cost of overseeing the tendering process—the cost of lawyers, accountants and other advisers—they said that they do not collect that information?
I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?
The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend David Tredinnick. Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.
We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.
The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:
“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.
Is the Minister saying that the chief exec is wrong in his assessment?
The chief executive makes exactly the point. It was of course the Labour Government who introduced competition into the NHS. If the hon. Gentleman has a problem, he should take it up with his colleagues further along the Front Bench who they introduced competition into the NHS. Monitor, as the sector regulator, must now have regard to having better integrated services, reducing fragmentation and putting more emphasis on the best interests of patients.
The fourth effect of the Health and Social Care Act has been to provide clarity about existing NHS practices on patient choice and competition that were introduced by the previous Government. Under the Act, nothing changed from the rules laid down under Labour on how commissioners should behave when they procure services. That has been borne out, despite the myths and scare stories surrounding the Act. Simon Stevens, a former Labour special adviser under Tony Blair and now head of NHS England, said to the Health Committee that
“if the claim was that CCGs have to start putting all of their health service purchases out to public procurement, that is clearly not true and it isn’t happening”.
“The current rules are clear that no-one can pursue competition in the NHS if it is not in the interests of patients.”
Our NHS finances bear that out. In the last financial year, spending on independent health care provision by commissioners was shown to be about 6%, compared with 5% under Labour in 2010. That is hardly evidence of the sweeping privatisation of NHS services, but it is evidence of clinical commissioners making informed, clinically led choices for the benefit of patients.
Dr Steve Kell, chair of the NHS Clinical Commissioners, has made it clear that there is not a clinical commissioning group in the land that has any kind of “privatisation agenda”. What CCGs all share is clinical expertise and an unflinching desire to improve local health services for their patients. This Government will not stand in their way or play party politics with the judgments of doctors and nurses who are making the right choices in the best interests of their patients. Indeed, Dr Michael Dixon, chair of the NHS Alliance, and others wrote in The Daily Telegraph this morning:
“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.”
Working with other key health care organisations, NHS England—I hope that Labour Members will agree with this uncontroversial point—has set out how the health system must change over the next five years, looking at new models of care delivery and taking a more integrated approach to the delivery of health and care. Earlier in the year, the head of NHS England, Simon Stevens, made it clear that if the procurement, patient choice and competition rules stood in the way of delivering the required changes, he would say so. Clearly, he has not done so.
Let me be absolutely clear: the NHS England “Five Year Forward View” did not call for further legislative change—that is what the Bill proposes—or for structural upheaval or a return to Whitehall control of our NHS.
I am sure that we can all agree that NHS England’s “Five Year Forward View” was an important piece of work that deserves to have broad cross-party consensus.
Politicians now need to leave the NHS to get on with the job: let the doctors and nurses run the NHS as we have freed them up to do. We can support leaders in the system, and help to free more money for front-line care through improved NHS procurement, better estate management and reduced spending on temporary staff. However, making top-down legislative change to the system, as the hon. Member for Eltham proposes, would be disastrous at a time when we should focus on supporting our NHS to deliver better care for patients.
It is important to look at what the Bill would do. It is quite simply wrong to believe that removing the parts of the 2012 Act that relate to the competition will stop competition law applying to our NHS.
Is the Minister happy that, because of competition, groups such as Care UK have cut professional health workers’ pay by between 35% and 40%? How does he expect those people to feel motivated to go to work every day when they cannot afford to pay their mortgage or to look after their kids properly? Is that really what we should expect in this day and age?
The hon. Gentleman will be aware that Care UK provides a lot of the care in the social care sphere. I understand that much of the social care commissioned by local authorities is already provided by the private sector. The big idea of the right hon. Member for Leigh is about driving further integration. Under the integration plans that he has outlined, more power would of course be given to companies such as Care UK. We support integration, but it must be done in a way that always meets the best needs of local patients, and it must be evolutionary change rather than revolutionary change, working with front-line professionals to do the best for their patients.
Let me make a little progress on the damage that the Bill might do. As I have said, the belief that removing the parts of the 2012 Act that relate to the competition will stop competition law applying to our NHS is simply wrong. That important point goes to the heart of what the right hon. Member for Leigh has said.
If the hon. Lady will let me make some progress, I will come to her shortly.
The fact that such a belief is wrong was recently made clear in correspondence from Simon Stevens to the right hon. Gentleman—from one former Labour special adviser to another—which stated:
“We are, as appropriate, required to observe European procurement regulations, originally introduced in 2006, and related UK law. In everything we do we are also required to exercise our functions effectively, efficiently and economically. As a result we are advised that a blanket contracting ban would not be permissible.”
It would not be permissible because of regulations introduced by the previous Labour Government. That is another reminder that Labour introduced competition into the NHS.
As I explained earlier, under changes introduced by the previous Labour Government, health commissioners were subject to EU competition law for several years prior to the Act, and they would continue to be subject to it even if the Act was repealed.
The points the Minister is making about competition take us back to the transatlantic trade and investment partnership. He must be aware that the NHS across these islands is developing in very different directions, and competition has not been at the heart of what has happened in other parts of the UK. I want him to give us cast-iron guarantees today that there will be no obligation on the NHS in Scotland to open up because of that trade agreement, even if the UK decides in its favour. What opportunities are there, if the treaty exposes the Scottish Government to—
I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and Mr Weir.
The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.
Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.
I am glad that my hon. Friend has mentioned Macmillan. At the moment, Macmillan is in the middle of tendering for end-of-life and cancer care in Staffordshire, which hon. Members have mentioned. Although the integration that the tender requires is absolutely vital—I think that it is supported by all Members, including Tristram Hunt in a recent article—one of the real problems involves the mechanism. The fact is that the integration seems to require the tender to be for the entire service, rather than for just a small contract, say, to help with integration. Will he comment on that, because this is one of the problems at the heart of the matter? We do not want large private companies to run our cancer and end-of-life services.
In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the Bill, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.
Points were made about the voluntary and charitable sector supporting innovative new models of care. Through the Newquay pathfinder project Age UK has provided volunteer support to vulnerable older people considered at risk. Under the home scheme the British Red Cross provides volunteer support to patients in their homes, which is aimed at preventing admission to, or facilitating discharge from, hospital. The charity has care in the home contracts with more than 30 NHS trusts and social services departments, and the scheme enables reduced admissions, increased convenience to patients, and many other associated benefits.
My hon. Friend Jeremy Lefroy mentioned Macmillan. I like to talk about Macmillan, which has long provided vital support to patients right across the UK. It is collaborating with doctors in Staffordshire to transform cancer care and end-of-life care, and together they aim to commission care right across the patient journey. In cancer, that means commissioning prevention and health promotion, ensuring early diagnosis and prompt treatment through survivorship and improving end-of-life care.
In reality, the only route proposed in the Bill for recourse against unfair treatment by commissioners is to take us back to the previous Labour Government’s competition laws in 2006 and open up legal challenge through the courts. Only private providers with enough resource behind them are likely to be able to afford to exist in that court-based system, to pay high legal fees, and to invest in providing NHS care to patients, and smaller providers, especially charities, will lose out. Surely we do not want to see that in our NHS—an NHS in which, I hope we all agree, charitable and small local health care organisations have something important to contribute for the benefit of patients.
Before I conclude, I must briefly address some of the misleading commentary that has surrounded TTIP, which is serving only to distract from the real debate about our NHS. First, may I state that there is absolutely no agenda whatsoever to privatise our NHS through the back door? TTIP cannot force the privatisation of public services by EU member states. This position has been made explicitly clear by us and by the relevant negotiating parties. To suggest otherwise would be disingenuous and, frankly, wrong. I encourage Members to look at the recent negotiating mandate published by the European Commission, where this position is made absolutely clear. I note the comments of Ignacio Garcia Bercero, EU chief negotiator, on the record at the end of round 7 negotiations—
I am addressing the hon. Lady’s point, so I hope she will let me do so. Ignacio Garcia Bercero said:
“I wish…to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”
That is a very clear reassurance, and I hope it will be accepted by all hon. Members. I will give way just once more, because I do not want to test Mr Deputy Speaker’s patience as I come to a conclusion.
I am grateful to the Minister, but my understanding is that the Commission has said that if one part of the UK market is opened up through privatisation—perfectly democratically, as it could be—then all parts will be opened up. I want his assurances that Scotland will not be forced, by the back door, to privatise its NHS on the coattails of this House.
The Government’s health care reforms ensured that, as under the last Labour Government, day-to-day decisions of care delivery became the responsibility of clinically led NHS commissioners. It is for the local NHS to decide which providers, whether from the public, private or voluntary sectors, can best meet the needs of their patients and deliver high quality care.
On a point of order, Mr Deputy Speaker. I do not know what is going on with this speech. I know that the Minister is a distinguished medical person, but he is presenting the speech with so much jargon and such technical terms that very few people out there will understand the main thrust of it. The only thing many people have understood in the last few minutes is the back-door privatisation.
That is absolutely not a point of order, but we will hear from some other speakers if we can get to the end of this speech. We might then hear some other parts of the debate.
Thank you, Mr Deputy Speaker.
I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that Mr Sheerman does so.
Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for John Healey, a previous shadow Health Secretary, when he stated:
“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”
If it was good enough for the right hon. Gentleman—
That really will not wash. The Minister is saying that we must trust the Government and that they will not allow TTIP to apply to the national health service. The Bill says that this House will be sovereign; this House will decide whether TTIP applies to our national health service. Does he support that?
I was simply quoting the reassurances that his right hon. Friend had given to all hon. Members, which was that
“any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS”.
If TTIP is good enough for the right hon. Member for Wentworth and Dearne , it should be good enough for everyone in the Labour party.
No; I am simply quoting what the right hon. Gentleman has already put on the record about reassurances that he has received from the EU about an EU trade settlement. Surely, if the reassurances were good enough for him when he wanted to communicate them more broadly to his colleagues, and more broadly to members of the public, they are good enough now. It is very difficult to climb down from those reassurances, which he has previously given, and in the remarks I have made I have further reassured the House about the protection that this Government have made for the NHS in TTIP.
I am immensely proud of the way our NHS has already responded to the challenges of a growing and ageing population, meeting increased demand through a purpose and drive to improve the quality of patient care. That is why our NHS was recently ranked No. 1 in the Commonwealth Fund’s assessment of 11 global health care systems. This is at a time of unprecedented challenge to public finances across the globe, and testifies to the incredibly hard work of NHS staff and a very tough choice by this Government to protect our NHS budget and increase it by £12.7 billion between 2010 and 2015—a decision that the right hon. Member for Leigh called irresponsible but one of which we are very proud.
I remind the House of the words of the right hon. Member for Leigh when he was a Health Minister defending Labour’s record on introducing private providers into our NHS:
“I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision”.
I agree: it is definitely time to move on. Our NHS focus needs to be on delivering for patients, so let us put distractions aside and let our hard-working doctors, nurses and health professionals get on with the job.
I congratulate my hon. Friend Clive Efford on his excellent opening speech—I think it was one of the best speeches I have heard in the House—and on introducing his Bill so that we can review and reform some of the more pernicious effects of the Health and Social Care Act 2012. One of the worst was to force market tendering of services, meaning that millions of pounds are wasted on the process, money that should be spent on improving front-line patient care.
As a member of the Health Committee, I am very concerned about the increasing role that private companies are paying in providing NHS services. We recently looked at what is happening in Stoke and Staffordshire. There have been a few references to that in this debate and I will talk some more about it, but we looked at it under the label of the integrated care pioneers pilot. I want to talk more about that development as an example of just what can happen under this Government’s market framework—[Interruption.]
Order. There are a lot of conversations and I am struggling to hear the hon. Lady. If we need to have the conversations, can we turn them down a little?
Thank you, Mr Deputy Speaker.
The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.
By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.
As I have already said, I have major concerns about the form of the contract. Tristram Hunt wrote, and I say this in defence of Macmillan:
“This is the context for our new cancer contract and we should not pass knee-jerk judgments upon new ideas which aim for better outcomes and efficiency.”
That is what Macmillan is after.
I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.
Indeed. Now that the shortlist for bidding has been announced for end-of-life care, we find that five of the shortlisted bidders are private companies, with only two NHS trusts on the list. For cancer care, there are three private companies and two NHS trusts. Given the seemingly headlong drive for change we found in those commissioning this large and risky contract, a great number of questions were left unanswered. For instance, despite the key role that GPs play in end-of-life care for patients choosing to die at home, the prime provider of end-of-life care will not have control over the actions of the GPs involved in that care unless a specific contract is drawn up and GPs are paid for extra tasks.
The contracts for cancer and end-of-life care are to be placed in early summer 2015, and I invite anybody with an interest in this to review the evidence and, in particular, the unanswered questions in the session the Health Committee held on
Cancer care for north Wales is provided by bodies in the north-west of England. MPs on the Government Benches are saying that I, as a Welsh MP, should not have a vote on this matter. What does my hon. Friend think about that? Should I be concerned about standards of care and the privatisation of the English health service? My constituents will suffer if it is hollowed out and privatised by the Government.
My hon. Friend absolutely should be concerned and I know that he is.
One of the elements of cancer and end-of-life care given to us as an example of where improvement is needed in Staffordshire and Stoke was patient transport. However, we know in the north-west that going to new private providers does not tend to help. We have already had a negative experience since patient transport was contracted out to the bus company Arriva.
A number of my constituents have had problems with Arriva’s patient transport. One contacted me following a wait of more than three hours for ambulance transport to be arranged for her husband. He has terminal cancer and needed to be transported back to Salford Royal after oncology treatment at the Christie hospital. That was the second time in three weeks that this terminally ill patient had to wait two or three hours for transport. Staff at the Christie hospital told my constituent that such long waits were common, despite the fact that many oncology patients are very sick.
I am very grateful to my hon. Friend for giving way, particularly because the Minister did not in the course of his very long speech. Of course, that might have been because the main emergency hospital in my constituency, Charing Cross, is being demolished, losing all but 24 of its 360 beds, losing the best stroke unit in the country and losing its A and E, which, according to board papers, is moving from the site. There will be no emergency consultancy services at all. Is not what is happening on the ground very different from the jargon-filled rubbish we heard from the Minister today?
Absolutely, and I am saying what is happening on the ground to a terminally ill cancer patient.
In her letter to Arriva, my constituent told the company:
“Your company should not have this contract if it displays such a lack of concern for very ill patients causing distress to both them and their relatives”.
Not only was the delay unacceptable to a terminally ill patient, but the reply to my constituent’s complaint was one of the worst I have ever seen, as we are talking about gobbledegook. For instance, the explanation for the long wait included the following sentence:
“When an outpatient booking is made, the expected outbound blocking is automatically populated, using the throughput assumption.”
The jargon that starts at the top permeates down even to the complaint handling. It took a lot more letters to get an apology for such appalling service and such a poor reply.
Another constituent has told me of unsuitable transport and untrained staff—we have heard about this happening across the country—sent to the home of a patient who needed to use a wheelchair. That meant that the patient missed their appointment and an important investigation of their health was delayed by a number of weeks. I trust that the commissioners driving the privatisation of cancer services in Staffordshire and Stoke are aware of just how wrong transport services can go with a private transport provider.
This Government’s measures have put competition and privatisation above the needs of NHS patients. The Health and Social Care Act has put pressure on regulators to make clinical commissioning groups and NHS trusts adopt tendering processes that are not in the best interest of patients. That means wasted money, resources and time. This Bill would remove these damaging reforms, and patient care would be prioritised instead of unnecessary competition. The Bill would not prevent competition within the NHS, but it would prevent competition at the expense of patient care.
Our national health service is different from other sectors and needs a different approach. Integration to improve patient care needs collaboration rather than competition. It is a great pleasure to be in the Chamber today to speak and vote in support of the Bill.
I am grateful to have the opportunity to make a few short remarks. Barbara Keeley is right to be concerned about any problem that occurs in the NHS, but I am sure she would accept that it is an enormous organisation and that the key point is that when things go wrong, the lessons are learned and things are put right. Most of the life of the NHS has been under Conservative Governments, and we on the Government Benches are as proud of the NHS as Labour Members are.
I congratulate Clive Efford on being a strong voice for Labour principles, but I am concerned that the effect of his Bill will be to undermine the operational independence of the NHS, cause disruption and introduce unnecessary bureaucracy. Putting powers back with the Secretary of State through the re-establishment of powers of direction is going in the wrong direction. Preventing illness, diagnosing and treating patients are not political activities. They should be in the hands of professionals and the operational independence of the NHS means that clinical considerations are paramount. When I was a Health spokesperson, I went to look at health systems in Europe, and the key point I took away was that the best systems were those with a lot of clinical input in management.
It is not necessary to rewrite the Act. Instead, the changes we have made need to work their way through. The shadow Secretary of State said that the competition element is dominant in the Act, but that is not true. The procurement policy is set out to secure the needs of patients and improve quality and efficiency. I want to give an example from my constituency of how the reforms are working. Royston is part of the Peterborough and Cambridge CCG. Before that was so, we had a proposal for the redevelopment of Royston hospital. A Royston hospital action group was formed, while the friends of Royston hospital were concerned about the proposals, which were top down. However, Tom Dutton, the CCG strategic lead, has worked tirelessly with the NHS and the local community, as has the local chairman, Dr John Hedges, a GP in Royston, and they understand local needs, so we are now getting tailored provision that suits the needs of my constituents.
I meet the CCG, councillors, local groups and other stakeholders every six weeks, and I believe that we are now getting a service for Royston and a proposal that meet local needs. The £1 billion tender for older people’s services was in our CCG area. Clive Efford criticised the cost, but we had a consultation meeting in Royston that 150 local people attended, while 250 local people filled out the questionnaire. The proposal and consultation will have cost money, yes, but the end result was that the tender process was won by the Uniting Care partnership, an NHS partnership involving Addenbrooke’s hospital and the Cambridge and Peterborough NHS trust, and it is now delivering more joined-up care.
I was delighted with that outcome. One of the successes I hope the hon. and learned Gentleman will mention is the better joint working between acute care, mental health care and community services to avoid delays in the transfer of care. This could be a very good outcome for the NHS and patients.
That is exactly the point I was going to make. The process, which involved local people, has resulted in a reform that gives us the sort of joined-up care the hon. Gentleman mentions.
To conclude, the Bill seeks to prevent privatisation that is not happening on the ground, while some of the changes we have made are bringing positive benefits for people in my constituency.
I would like to offer my support for the Bill and congratulate my hon. Friend Clive Efford on bringing it to the House.
Members will be pleased that I intend to keep my comments brief. Our NHS is a monumental achievement and one that my party remains deeply proud of. There are many people alive today who remember what life was like before the NHS and who would never go back to a time when the poor could not afford treatment for preventable illnesses. That is the generation that truly understands what the NHS means and why we must protect it.
That is not to say that people today take the NHS for granted. In fact my inbox, like those of other hon. Members, has been overflowing with e-mails from constituents worried about the future of our health service. They want the principle of free and equal access protected and the needs of patients put before profit, as they should be. I and those people are afraid of the direction the NHS is heading in under this Government. We see the Tories wedging open the door for private companies to come in and deliver services, and we see hospitals encouraged to take on ever more private patients.
People do not believe the Government’s spin: they know that the changes are part of the creeping privatisation being encouraged by the Tories and that the reorganisation in the 2012 Act was all about Tory ideology, not patient care. The reorganisation wasted £3 billion and has seen millions more spent on tendering exercises and competition lawyers which could have been spent on treatment for those who genuinely needed it. They also know that they cannot trust a Health Secretary who has previously backed calls to dismantle the NHS or a party that brought the NHS to the brink of collapse the last time it was in power. Back then, it took a Labour Government to save the NHS, and now history is repeating itself.
The constituents who have written to me, the people I was proud to join on the NHS march earlier this year and those I joined last night for a vigil outside Parliament understand what is at stake. The NHS is more than just a service; it is a principle of fairness. Illness and accidents strike us all at some point, often without warning and leaving us little time to plan, and before the NHS, this kind of misfortune could destroy lives and condemn families to extreme poverty. Now we have a service that says nobody, whether rich or poor, should have their life ruined by misfortune. That is the principle that my hon. Friends and I are standing up for today.
My support derives mainly from my and my constituents’ experiences over several years of some of the workings of the Health Act 2006, introduced by the previous Government, and the 2012 Act, introduced by the this Government. In particular, two matters have been, and continue to be, of great significance: first, the two Francis inquiries into cases of dreadful care in my constituency, and secondly, the reports that have had such a major influence on the entire NHS. Just yesterday, my wife was giving a lecture to medical students on aspects of the Francis reports. It is vital that these lessons, particularly on patient safety and zero avoidable harm, are not forgotten, which is why I introduced a Bill on the subject two weeks ago.
The second concerns a more recent matter referred to already today: the review, supported by Macmillan, of cancer and end-of-life services in north Staffordshire, Stoke-on-Trent, Stafford and Cannock, which has resulted in a tender of all these services to be managed through an integrator. Just to correct the record, it is not just private companies on the tender—NHS organisations are also on it—but I still have major concerns. I am looking at this through the eyes of patients everywhere. The NHS must not be about structures or be in thrall to political dogma of any kind; it must be about safety and quality of care for all patients. I hope the Government might see the Bill in that way and use it as an opportunity to make improvements to both the 2006 Act and the 2012 Act.
I welcome clause 1. During the trust special administrator process that we had to go through, the inability of providers and commissioners to speak to one another—in some cases because of so-called commercial confidentiality —was ridiculous and without doubt delayed the process. At certain points, the whole process cried out for someone, if necessary the Secretary of State, to put everyone in a room for a day with instructions not to leave until everything had been sorted out. However, everybody was walking on eggshells in case they did something that might result in a judicial review and a reversion to square one. That was not in the interests of patients. That is not to be critical of those involved: for the most part they tried very hard and we got a better result than at some points we feared.
I want to make a serious point about clause 1 and the desire for the Bill to place the running of the NHS firmly in the hands of the Secretary of State. It is vital that there should not be too much hands-on running of the NHS by the Secretary of State—the British Medical Association, which has some very positive comments about the Bill, says that as well.
I am short of time, so let me conclude by talking about cancer and end-of-life services, which have been raised today. The problem is the way in which the NHS is funded and the fact that the tender is for all services involved in those pathways. It would have been much more sensible for the tender to help the work of integration, which would have involved a much smaller amount, rather than the full amount of services.
I ask the Serjeant at Arms to investigate the delay in the No Lobby.
The House having divided: