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I refer the House to my entry in the Register of Members’ Financial Interests: I work as a GP.
There may be people listening to this debate who work for private or voluntary sector organisations, providing services to patients or to the NHS. Most of them do a fantastic job. They are not employed by the NHS, but they do help our NHS, and I thank them for the work that they do.
When local people and local commissioners agree that it is in the best interests of local patients to use non-NHS services to deliver NHS care, that should sometimes be enabled. In the fields of medical technology and devices, pharmaceuticals, information management and many others, good private sector companies are working to support the NHS. But private sector involvement can also lead to a race to the bottom. When subsidiary companies reduce terms and conditions for workers, that is bad for us all; when privatised community services ignore the hardest-to-reach patients, that can widen health inequalities; and when private sector treatment centres cherry-pick the least-risky patients, do not contribute to training, and then expect the NHS to pick up the pieces when complications arise, the NHS loses.
All that is without mentioning the private Primary Care Support England contract, run by Capita. It is total disaster. The main function of support services is to enable clinicians to get on with the job of looking after patients, but GP registrars are not being paid on time, GPs are not added to performers lists, and one practice manager told me that it took four months and 16 emails to transfer a GP from being salaried to being a partner. This work needs to be taken back by the NHS; Capita has failed.
What vision do I think we should have for our NHS? I endorse the Government’s goal of integrated health and care services built around patients’ needs. That is the only way to meet the health challenges of this century. The Health and Social Care Committee, on which I serve, has looked in detail at moves towards the integration of care through sustainability and transformation plans, accountable care organisations and integrated care systems. We have seen real potential to improve the quality of care for patients, to make the strategic shift away from reactive care to proactive care, and to transfer more NHS resources into keeping people well rather than just fixing them when they get sick. The need to bring together primary care, community care and social care has widespread support in the NHS, but we should do that within a health and care service, run by the NHS, owned by the NHS, and led by the NHS.
There are understandable concerns about the integration agenda being used to encourage more private-sector involvement. The Government and NHS England say that that is not their intention, but speculation could easily be dispelled by legislating to make accountable care organisations—if they happen—NHS bodies. I am talking about NHS-owned and NHS-led organisations running health, and even care services, for whole populations. What a great legacy that would be, with procurement not being forced on commissioners, with the private sector being used only when it enhances the ability of the NHS to help patients, and with no cherry-picking and no dilution of hard-won employment rights for any staff providing services to and for the NHS.
The Government should bring forward legislation to repeal section 75 of the Health and Social Care Act 2012, accountable care organisations should be cemented in primary legislation that makes them NHS bodies, and the Primary Care Support England contract should be brought back into the NHS.