House of Commons
Friday 21 November 2014
The House met at half-past Nine o’clock
[Mr Speaker in the Chair]
The following Member took and subscribed the Oath required by law:
Mark John Reckless, for Rochester and Strood.
National Health Service (Amended Duties and Powers) Bill
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.]
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 the right hon. Member for Sutton and Cheam (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 it. 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 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 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.
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 is making a tremendous speech. Will he confirm that clause 14 is absolutely crucial across the United Kingdom, including Scotland, given the potential impact of TTIP?
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.
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, and 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, the right hon. Member for South Cambridgeshire (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 the hon. Member for Eltham (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.
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.
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.
The picture is not quite as rosy as my right hon. Friend paints it, is it? Even The Guardian newspaper reported that the Commonwealth Fund survey showed that the
“only serious black mark against the NHS was its poor record on keeping people alive.”
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.
In the introduction to the NHS plan of July 2000, the then Secretary of State for Health, Alan Milburn, wrote:
“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.”
I am big fan of the NHS. It is my NHS too. I was badly hurt in the Army in 1997, and the NHS sent me to get fixed as a private patient, because the NHS could not do it. I am very grateful to the NHS. That was under a Labour Government, and I hope such a scheme continues.
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 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 31 October 2000, under the last Labour Government? The printout that I have is entitled, “A Concordat with the Private and Voluntary Health Care Provider Sector”. It is headed, “Socialist Health Association—Promoting health and well-being through the application of socialist principles”. It was a concordat introduced by the previous Government with the private and voluntary health care sector. It says:
“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 31 October 2000.
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”
“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 the Member for Central Suffolk and North Ipswich (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.”—[Official Report, 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, but that
“the merger removes important competitive constraints for elective head and neck, ENT, OMF, urology and symptomatic breast care services in the absence of other competitors”.
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 the Member for Eltham (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?
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 the right hon. Member for Holborn and St Pancras (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 the hon. Member for Easington (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.
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 benefiting 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 the right hon. Member for Banbury (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.
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, the right hon. Member for South Cambridgeshire (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”.—[Official Report, 31 January 2011; Vol. 522, c. 617.]
Of course, it was not and it is not. As I argued, at the time from the Opposition Front Bench:
“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.”—[Official Report, 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 the Member for Leigh (Andy Burnham) makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend the Member for Eltham (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, the right hon. Member for South West Surrey (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 the new Member for UKIP, the hon. Member for Rochester and Strood (Mark Reckless) or his colleague, the hon. Member for Clacton (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 2010-11, 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 use 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 the right hon. Member for Banbury (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 the right hon. Member for Wentworth and Dearne (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 the hon. Member for Eltham (Clive Efford) to accept such an amendment if the Bill made progress?
If the hon. Member for Eltham (Clive Efford) 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 the hon. Member for Eltham (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.
And indeed on this side of the House.
It is a particular pleasure to speak on a Bill introduced by the hon. Member for Eltham (Clive Efford), because I have spent time in the past few weeks defending myself following allegations from the Conservative party that I grew up in his constituency, in SE9.
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 the hon. Member for Southport (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.
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 near 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.
It might be helpful for the hon. Gentleman to bear in mind the words of his colleague, the hon. Member for Clacton (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 (Douglas Carswell) 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 the hon. Member for Totnes (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 11 February 2012, on his TalkCarswell.com website—
“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. Member for Rochester and Strood (Mark Reckless) 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.
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 the hon. Member for Rochester and Strood (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 the hon. Member for Eltham (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 been listening to the right hon. Member for Wentworth and Dearne (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.
My FOI request to the Shrewsbury and Telford Hospital NHS Trust elicited the following response—it is a short paragraph, so if I may, I will read it out:
“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 the hon. Member for Walsall South (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 the right hon. Member for Wentworth and Dearne (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 the Member for Charnwood (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 the Member for South Cambridgeshire (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 the Member for Central Suffolk and North Ipswich (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.
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 and homeopathic doctors are regulated by separate Acts 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 a 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.
Tuesday 20 March 2012 was a black day for the NHS and for this Parliament. A Bill with no mandate from the British people was allowed to pass through this House and to place market forces at the heart of our health service. It allowed this democratic House to be bypassed when it comes to decisions affecting the country’s most valued institution. In other words, it was a crime against democracy and the national health service. Ever since that dark day, the damage has been mounting: NHS services worth billions of pounds—including blue light 999 ambulance services and cancer services—forced out to open tender; millions of pounds thrown at competition lawyers and consultants to run those tenders; and NHS hospitals, freed to earn up to 49% of their income from treating private patients, doing just that and letting NHS waiting lists get longer.
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 the Member for Eltham (Clive Efford), restores the right values at the heart of the NHS: collaboration over competition; integration over fragmentation; people before profits.
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 2012 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. [Interruption.]
“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 the Member for South Cambridgeshire (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 the hon. Member for Cambridge (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 the Member for Bolsover (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?
We have spineless Government MPs who will not come here today to argue for the Act.
I congratulate the hon. Member for Rochester and Strood (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 the hon. Member for Clacton (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 recall much of what the right hon. Gentleman said from the Dispatch Box in 2012, and I would like to credit him because a lot of it has come to pass. He was perspicacious in much of what he said and many of the assurances that I was given from the Government Front Bench have been found wanting.
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 the hon. Member for Bosworth (David Tredinnick) and the right hon. Member for Banbury (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 9 July 2005:
“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 if there is only 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”.
We also take for granted the key role played by charities and the voluntary sector in providing NHS care to patients across the country, notably Macmillan Cancer Support and Marie Curie Cancer Care.
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”.
Those are not my words, but those of Labour Prime Minister Tony Blair about the reforms to the NHS that he introduced under the previous Labour Government.
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 the hon. Member for Rochester and Strood (Mark Reckless). He failed to address the issues that I had raised earlier about the support that the hon. Member for Clacton (Douglas Carswell), his party colleague, gave to the Health and Social Bill—now the Health and Social Care Act. In fact, as the right hon. Member for Leigh (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 reaffirm 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 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.]