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National Health Service Bill

Volume 607: debated on Friday 11 March 2016

Second Reading

I beg to move, That the Bill be now read a Second time.

It is an honour to have brought this Bill to Parliament today. It is the result of widespread consultation and has extensive backing from a raft of doctors and nurses delivering front-line care, as well as from local NHS campaign groups. Its backers include the British Medical Association council, the president of the Royal College of Paediatrics and Child Health and many local NHS staff and campaigners. I want to pay tribute to them all for their amazing work. I pay tribute, too, to Allyson Pollock, the professor of public health research and policy at Queen Mary University of London, and to Peter Roderick, a barrister and senior research fellow there, for their expertise and help.

The incredibly positive and wide-ranging popular support for the Bill reflects a strong belief in a publicly provided NHS. People are rightly worried because the NHS, consistently ranked one of the best in the world, is under threat like never before. It is under threat from underfunding dressed up as efficiency savings; under threat from cuts; under threat from the wasteful bidding of the internal market; under threat from increasing commercialisation and the steep increase in corporate sector contracts since the Health and Social Care Act 2012.

A Select Committee on Health report in 2010 showed that the NHS’s running costs had more than doubled from 6% to 14%, based on the purchaser-provider split, and that was before the outsourcing and tendering of the Health and Social Care Act 2012.

I am grateful to the hon. Lady, who speaks with great expertise in this area. She is absolutely right that the creeping privatisation and marketisation are, along with all the other problems they bring, incredibly inefficient.

I am sure that everyone in the House sympathises with the lack of time for Second Reading of the hon. Lady’s Bill. Does she agree that the NHS is also direly threatened by the imposition of brutal pay restraint policies that do such damage to recruitment and retention, particularly in places such as Oxford?

I absolutely agree with the right hon. Gentleman. It is no wonder that we cannot recruit more nurses and doctors when the Government treat them so badly and their expertise is so unappreciated.

Further to the point that my right hon. Friend the Member for Oxford East (Mr Smith) made, the Government extol the virtues of those who work in the national health service, yet they have offered them a paltry 1% pay rise. Does the hon. Lady think they could do better than that?

Yes, I was about to come on to that exact point. The 1% pay rise is frankly insulting. It is unsurprising that there is so much concern among NHS staff, because it is not only about finances but about how they are being treated in general. We have a Health Secretary who constantly undermines their professionalism, helping to push our NHS into crisis.

To see off the many threats facing our NHS, the Bill is guided by the principles of the National Health Service Act 1946. It would reinstate the Secretary of State’s duty to provide services throughout England. It is time to put an end once and for all to the purchaser-provider split, which is the harmful cornerstone of the commercialisation of our health service. It is the open door that lets the health corporations in to pick off the most profitable NHS contracts.

I congratulate the hon. Lady on bringing forward this Bill, which attempts to stop the dismantling of the NHS in England and Wales. Does she appreciate that that dismantling poses a threat to the NHS in Scotland, because our funding is linked to English public expenditure through the Barnett formula? Does she also recognise that Scottish National party MPs are here in numbers today at the request of their constituents?

The hon. and learned Lady is absolutely right. I am grateful to my SNP colleagues for being here today and for being patient as we waited to get to this point. What happens to the NHS in England has consequences for the NHS in Scotland. They are absolutely linked, which is why I am so grateful that she and her colleagues are here today.

If the hon. Gentleman does not mind, I will not, simply because I want to make a bit more progress and many Opposition Members have waited a long time to speak in this debate.

The purchaser-provider split has allowed NHS privatisation in England to increase dramatically since the 2012 Act. The most recent official figures show that the NHS paid £6.6 billion to private healthcare firms in 2013-14. Some have suggested that that figure has now increased to as much £10 billion.

The Bristol clinical commissioning group, which issues contracts for local NHS services, is in the process of striking out rules that prevent tax-avoiding private companies from securing NHS contracts, for fear of litigation. Does the hon. Lady share my worry that the only health concern for some private contractors is ensuring that they get healthy profits?

I remind the hon. Lady that Labour Members are also here. As a member of the Health Committee between 2010 and 2015, I know that the Bill is vital. Does she agree that it is necessary to overturn the reorganisation that nobody wanted and that cost £3 billion?

I pay tribute to Labour colleagues who are here. Unfortunately, there were not enough to ensure that we could have had a closure motion earlier, about which I am sorry. However, the hon. Lady is absolutely right that we need to tackle reorganisation head-on. Some will argue that the NHS cannot face yet more reorganisation. I agree with that on one level, but the alternative of carrying on down the current route is absolutely impossible. The Bill is framed in such a way to ensure that reforms are implemented organically over time. Frankly, I do not think that we can do without it.

The NHS is being reorganised on a daily, weekly and monthly basis. Every time a service is outsourced, it is completely reorganised. By being taken over, people’s contracts are altered, and the shape of the service changes. In Scotland, we reversed the purchaser-provider split in 2004, and it was relatively painless. What we need is simply a decision not to outsource further and gradually to move back to geographical health planning instead of the fragmentation of clinical commissioning groups at a time when we need integration.

That intervention is incredibly helpful, as it shows what is possible. The fact that it has been done in Scotland without major problem demonstrates that, if the political will is there, changes can be made.

The urgency of the Bill is notable. In my constituency, a hospital was closed within five days because of competition and the fragmentation of services. Is it not essential that we do everything we can to bring about a collaborative, planned service now?

I am grateful to the hon. Lady for her intervention. She must have very good eyesight, as I was about to come on to exactly that point. We need a planned service, not one based on competition all the time. To those who say that the private sector is only a small part of our NHS, I make three important points. First, the private sector causes enormous harm by cherry-picking profitable services. Secondly, there has been an undeniable escalation of private sector involvement since the Health and Social Care Act 2012, and the direction of travel is plain. Thirdly, material harm is being caused by the purchaser-provider split, which puts competition above co-operation and sees NHS bodies literally bidding against each other, and I simply cannot see whose interest that is in.

No, I will not, because the hon. Gentleman has already had about two hours in which to speak this morning.

I will say a little more about each of those points. On cherry-picking, the inescapable truth is that the private sector is camping out on the NHS’s lawn. It is using all the corporate machinery available to it to pick off the low-hanging fruit—the non-urgent, easy and profitable services. The 2012 Act handed the private sector unprecedented access to NHS markets. Invited in to browse, it has predictably seized the simple, profitable work, sending complications back to the NHS to mop up any mistakes or unforeseen outcomes.

I have asked on several occasions in the Chamber about the contribution of the Health and Social Care Act to the current financial state of the NHS in England. We constantly hear that it is all just due to agency nurses, yet when we look at the five years before the change, we see that the NHS managed, somehow, to balance its books. It then had a debt of £100 million, then £800 million, and now we are looking at a debt of £2.5 billion. That is because we are not looking after everyone. We are giving the private sector the cheap people and the NHS ends up with the expensive people.

I thank the hon. Lady for bringing the Bill to the House—I am glad that she has finally been able to do so. Does she agree that the real issue with the privatisation of the health service is that the money that is made goes into the pockets of shareholders and not back into patient care?

Absolutely. It is just criminal that the money that the NHS so desperately needs to provide front-line care is going to line the pockets of private companies’ shareholders.

No, I will not. I will not give way to a gentleman who has spent about two hours boring on this morning.

The private sector is profiting from NHS training, but it is depriving the NHS of income and removing valuable day-to-day training experience. Let us take the example of a surgeon who no longer gets to practise on scheduled elective work and who, as a result, has to refer an emergency shoulder injury to a specialist unit. It could have been dealt with at a lower level, but the experience and practice were lost.

I congratulate the hon. Lady on bringing this Bill forward. In communities such as mine, in Whitehaven, Millom, Keswick, Maryport, Workington and elsewhere, we are really feeling the effect of Government policy right now—there are no two ways about it—as it is hollowing out the NHS. The Bill requires a lot of work, and I do not favour another reorganisation. Where in the Bill would provision be made for the NHS to recognise explicitly the difficulties and differences in providing healthcare in isolated rural peripheral areas? It is fundamentally different from how it is provided in more urban areas.

I thank the hon. Gentleman. I think that point will be explored in Committee. I cannot point him right now to the relevant clause, but it is a serious point. I would say that we will have a better chance of having such a managed and planned NHS, in which we can ensure that there are appropriate services in rural and urban areas, if we have a guiding mind back in charge of the NHS. That is exactly what was broken by the provider-purchaser split. The hon. Gentleman’s point is a good one, and I would love to see it debated further in Committee.

When it comes to the overall direction of travel and the duty to provide, it is shocking that the private hospital share of NHS-funded patients grew rapidly between 2006 and 2011. By 2010-11, private companies performed 17% of hip replacements and 17% of hernia repairs, and handled 8% of patients. First attendances for orthopaedics or trauma, such as broken limbs, also increased, yet it is the NHS that invests in training and picks up the pieces when things go wrong in the private sector, and it is the NHS that so often innovates.

Following the coalition’s Health and Social Care Act 2012, the NHS Support Federation has been charting the impact of Government policy on the use of outside providers to deliver and plan NHS care. Its report, which came out last month, charts the continuing steep escalation of creeping private sector involvement in the NHS. Its research shows that more than 400 NHS clinical contracts, worth £16 billion, have been awarded through the market since April 2013. Over that time the private sector has won nearly £5.5 billion of them, so let me give a few examples of the kind of corporate takeover that we are talking about.

In September 2015, Capita, despite its chequered record in the provision of public services, took control of a contract worth £1 billion to be the provider of primary care services in England. In October 2015, Virgin Care won a five-year, £64 million contract from Wiltshire clinical commissioning group, Wiltshire Council and NHS England to provide community child health services in Wiltshire. As of April 2016, services including children’s specialist community nursing, health visiting and speech and language therapy will all transfer to Virgin Care. In my constituency, the private company Optum, part of the giant American corporation UnitedHealth, last year won a £1.5 million contract from Brighton and Hove CCG for referral management services.

Such outsourcing goes on despite a trail of failed, terminated and collapsed contracts, such as the £235 million contract for provision of musculoskeletal services in West Sussex, which was awarded but never begun once it was determined just how much damage it would do to other NHS services in the region. Then there was the collapsed £800 million contract for Cambridgeshire and Peterborough older people’s services. There are estimates that the collapse of that contract has cost the local hospitals, GPs and community care providers about £20 million. There is a third example, of course—that of Circle, the private company running Hinchingbrooke hospital, which pulled out after just two years of a 10-year contract. That company’s announcement came just after the publication of a damning report on the hospital from the Care Quality Commission that raised serious concerns about care quality, management and the culture at the hospital.

One of the areas in which I have concerns relates to the case of Mid Staffordshire. A lot of the blame in the Francis report was on the drive for foundation status, which meant that senior management were totally fixated on that instead of on the quality of care to the patient. Consideration should be given to clinical governance, so that management are responsible for the clinical outcomes and not just the financial outcomes.

I thank the hon. Lady for making that important point.

In the last moments that are left to me in this debate, I want to talk a little about how what is happening to our NHS, sadly, did not just happen with the 2012 Act. It goes back further than that. To protect the NHS for future generations, we need to recognise that there were several other stealthy acts of vandalism before that Act. Margaret Thatcher’s Government introduced the internal market right back in the 1990s. The right hon. and learned Member for Rushcliffe (Mr Clarke) was in charge, following on from the so-called options for radical reform set out by the right hon. Member for West Dorset (Mr Letwin). In its 1997 manifesto, new Labour promised to end the Tory internal market but afterwards embedded it even further.

On those foundations, the now Lord Lansley, Secretary of State for Health in the coalition, drove forward the Health and Social Care Act. With that Act, no longer do the Government or anyone else have a legal duty to provide hospital services throughout England. That duty to provide was severed. Universal provision was replaced with commissioning for registered patients. Healthcare was thrown open to “any willing provider”—hastily changed to “any qualified provider”.

Shockingly, last October we learned that Lord Lansley has since been hired as a consultant to Bain & Company, which, according to its website,

“helps leading healthcare companies work on the full spectrum of strategy, operations, organization and mergers”.

That appointment at Bain was signed off in July 2015 by Baroness Browning, who herself chairs the Advisory Committee on Business Appointments—

The debate stood adjourned (Standing Order No. 11(2)).

Ordered, That the debate be resumed on Friday 22 April.