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National Health Service

Volume 613: debated on Wednesday 13 July 2016

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a bill to re-establish the Secretary of State’s legal duty as to the National Health Service in England and to make provision about the other duties of the Secretary of State in that regard; to make provision about the administration and accountability of the National Health Service in England; to repeal section 1 of the National Health Service (Private Finance) Act 1997, sections 38 and 39 of the Immigration Act 2014 and Part 9 of the Health and Social Care Information Act 2012; to make provision about the application of international law in relation to health services in the United Kingdom; and for connected purposes.

It is a privilege to have the opportunity to present this Bill to the House. I pay tribute to the many patients, nurses, doctors, trade unions and campaigners across the country who have been working tirelessly to combat the privatisation of our national health service. I also pay tribute to my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Brighton, Pavilion (Caroline Lucas) for the work that they have done.

The Bill is intended to fully restore the NHS as an accountable public service by reversing marketisation in the NHS, abolishing the purchaser-provider split, ending contracting, re-establishing public bodies and making public services accountable to local communities. The Health and Social Care Act 2012 provided the framework for the privatisation of the NHS, and we are seeing that privatisation happen at pace. I believe that the Act brought in three core changes that are driving that privatisation. First, it removed the legal duty on the Secretary of State for Health to provide and secure a comprehensive national health service in England. Secondly, it included a requirement to put NHS contracts out to competitive tender in the free market, putting the profit motive at the heart of the service. Thirdly, it allowed NHS hospitals to make up to 49% of their money out of private patients.

The Bill makes the case for a planned, managed health service. It would reinstate the duty of the Health Secretary, lost under the 2012 Act, to provide a secure and comprehensive NHS. That is important because, under the current arrangements, clinical commissioning groups do not have to serve a particular geographic area and are not required to tend to all illnesses and conditions. In some areas, certain treatments, such as hip and knee replacements and cataract operations, are already being rationed. Reinstating the Secretary of State’s duty is vital to provide the Government accountability needed to maintain a comprehensive NHS.

The 2012 Act forces NHS contracts out to competitive tender in the marketplace, allowing private companies to cherry-pick NHS services from which they can make money. Since 2012, we have seen the effect of NHS contracts going to private companies—it undermines NHS services and the pay and conditions of staff and fragments the service. The sums of money involved are eye-watering. The Government would have us believe that only 6% of contracts go to private firms, but according to the NHS Support Federation, private firms won 36.8% of contracts in 2014-15, securing £3.54 billion of the £9.628 billion of deals awarded.

Does that matter? I say yes, absolutely, without question. Contracting out is very expensive. In the USA, the cost accounts for about 30% of healthcare expenditure, compared with 5% in the non-marketised NHS pre-1990. Any private company has a duty to generate profit for shareholders, but the money we pay through our taxes should be spent on patient care and should not go to shareholders. Putting healthcare contracts out to competitive tender means money being spent on marketing and contract lawyers that could be spent on patients. A proliferation of providers also means a proliferation of administrative costs and opens up opportunities for fraud.

The only way the private sector can reduce costs is ultimately by cutting quality, which might happen by a number of means—for example, by cutting the pay and terms and conditions of health service staff or by selling off nationally owned assets. As a nation, we hold our doctors, nurses and other NHS staff in high esteem, and it is important that we protect their pay and conditions. The Bill therefore includes a requirement for the use of national terms and conditions of employment for relevant NHS staff under the NHS Staff Council and its “Agenda for Change” system. It also includes provisions aimed at preventing the application of competition law and procurement rules to the NHS. It would abolish Monitor, the sector regulator that licenses health service providers and oversees the operation of procurement, choice and competition rules in the health service, and it would repeal sections of the 2012 Act relating to procurement, competition, tariff pricing and health special administration.

Under the 2012 Act, NHS hospitals can make up to 49% of their money from private patients. How they make it is up to them, but the startling fact is that they can do it. They can choose to devote 49% of patient beds to private patients, 49% of theatre time to private patients or 49% of consultants’ time to private patients—and absolutely nobody voted for it. It was in neither the Conservative party’s nor the Liberal Democrats’ manifesto, yet they went ahead and passed legislation to make it happen. That is nothing short of a national scandal. I ask hon. Members to reflect on what it would mean for their constituents if their hospital made such choices. How soon could that happen? In some places, it is happening already. The Royal Marsden hospital now makes 26%—over a quarter—of its money from private patients.

I turn to the NHS financial crisis, which we are all aware of, which is particularly notable in our hospitals and which is accelerating at a frightening pace. NHS trusts in England have recorded a deficit of £2.45 billion for 2015-16—the biggest overspend in the history of the NHS, nearly three times that of the preceding year and more than 20 times the 2013-14 deficit. Three in four hospitals predict that they will be in deficit this year, and the financial crisis is also having an impact on the delivery of care. In those circumstances, it is not difficult to see how hospital managers might feel that increasing the number of private patients they treat in order to generate more income is one of the few options open to them.

We can also look at the recent arrival of sustainability transformation plans to see the bigger picture. England has been divided into 44 areas, each of which is required to come up with an STP. The first priority for the STP is that CCGs and providers must cut expenditure, stay within budget for 2016-17 and continue to do so for the next four years in order to be entitled to access centrally controlled transformation funding. They will face tough choices—they could sell assets, cut services, ration services or actually charge for services. In that landscape, we can expect to see hospitals taking private patients to generate extra cash, putting NHS patients at the back of the queue.

Doubtless the Government would argue that hospitals will be able to reinvest the money earned from private patients, but that argument does not stack up. If we cut 49% of resources from NHS patients, waiting times will grow and the quality of service will decline. We will see the emergence of a two-tier health service: first-rate for those with the money to pay, but NHS patients receiving a much diminished service. The concept of a comprehensive service free at the point of use will be lost within a generation, and we will all face the real possibility of having to buy health insurance, just as people do in America.

Let us remind ourselves that these hospitals are ours. They have been paid for out of our taxes and are run by our NHS staff—they are not the Government’s to give away. This Bill addresses that and would remove the right of NHS hospitals to make 49% of their money out of private patients.

We will not be able to manage our NHS properly until we address the issue of social care. We are all aware of how important that is. Why should we settle for an NHS that is free to all who need it unless they are elderly or have complex needs? The Bill provides an opportunity to change that. It would give the Secretary of State a duty to exercise his functions with a view to integrating the provision of health and social care services. That integration was a key aim of my right hon. Friend the Member for Leigh (Andy Burnham) when he was shadow Secretary of State for Health in the last Parliament and formed part of the Labour party manifesto. I believe that families up and down the country would welcome that development.

The Bill would also provide for the transfer of financial obligations on NHS private finance initiative agreements to the Treasury, which would also be required to assess and publish those obligations. That would improve public health, stop the privatisation of the NHS and return it to its founding principles. It would remove competition and the profit motive as the drivers of policy and replace them with the public service ethos that has been the hallmark of the NHS since its foundation. The NHS is currently on life support, and the public, patients and NHS staff know it. The Bill provides a viable alternative. The NHS was 68 years old last week; we need to make sure it is there for all who need it for the next 68 years, too.

I rise to oppose the Bill, which is wholly based on a false premise. The hon. Member for Wirral West (Margaret Greenwood) said that the Bill was necessary to stop the privatisation of the NHS. Well, the privatisation of the NHS is not occurring, so going by her own words, the Bill is completely unnecessary.

The hon. Lady laid the blame for the so-called privatisation of the NHS on the Health and Social Care Act 2012, and she thinks that repealing that Act will therefore solve the problem of what she describes as the privatisation of the NHS. The hon. Lady, who cannot seem to be bothered to listen to the debate, even though it is about her Bill, might have acknowledged that the so-called privatisation of the NHS started long before the 2012 Act. In fact, it gathered pace during the time of the last Labour Government.

If we look at the figures for expenditure on private providers, we see that from a near standing start under the Labour Government, the amount of the total NHS resource expenditure going to private providers grew much more rapidly under the Labour Government than it has under this Government. The increase in resources going to those providers has actually slowed down; it is much slower than it was. It was the hon. Lady’s party that introduced the private sector into the NHS and allowed private sector providers to provide NHS treatment.

I welcome that, as it happens. I do not see it as a bad thing. If my constituents need hospital treatment on the NHS, they have usually had to go to either the Bradford Royal infirmary, in the constituency of the hon. Member for Bradford West (Naz Shah), or to Airedale hospital, in the constituency of my hon. Friend the Member for Keighley (Kris Hopkins). However, under the current provisions, whereby the NHS can allow private providers to supply services, my constituents can now go to the Yorkshire Clinic in my constituency for high-quality treatment. They are served much closer to their homes, and their treatment is still free at the point of need.

As far as I am concerned, that is the essential founding principle of the NHS that must be preserved—that treatment is free at the point of need. That is what matters to people. That is what they want when they need healthcare treatment—free, high-quality healthcare at the point of need, at a location that is convenient for them and convenient for their family members to visit. Whether that is carried out at an NHS hospital or a private hospital is neither here nor there, as long as they are getting treatment free of charge at the point of need. My constituents have benefited greatly from being able to have treatment at the Yorkshire Clinic rather than having to go to one of the NHS hospitals outside my constituency.

The last Labour Government, of course, were far worse when it came to giving contracts to the private sector. Those of us who were here at the time will know that they did not pay the same tariff—[Interruption.] The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) keeps chirping away from the Opposition Front Bench; if she listened, she might learn something. [Interruption.] Well she might, and other hon. Members might well too. Many of them were not here at the time, but those who were will recall—[Interruption.]

Order. The hon. Member for Shipley (Philip Davies) is exercising his democratic rights as a parliamentarian, so he must be heard—preferably with courtesy, but certainly without noise.

Thank you, Mr Speaker; I appreciate that.

I was making the point that when the Labour party gave out contracts to the private sector, it actually paid the private providers a higher tariff for carrying out that work than they paid NHS hospitals and providers. To my mind, that was a complete outrage. If Labour was so much against the private sector, why on earth was it paying private providers a higher tariff than NHS providers? It was the current Government who stopped that absurd practice and made sure that private providers were paid the same tariff as NHS providers. The hon. Member for Wirral West could have mentioned that in her remarks, but she failed to do so.

As I said, the whole Bill is based on a false premise, because it was the last Labour Government who introduced the private sector into the NHS and paid private providers more for carrying out the same work, and the current Government have dealt with that absurdity.

The hon. Lady was pretty quiet about the part of the Bill that deals with section 38 of the Immigration Act 2014, which she wishes to repeal. That section requires nationals from outside the European economic area who come to the UK for longer than six months to pay a health surcharge when making their immigration application. Although no statistics are yet available on the amount of revenue raised from that surcharge, an answer to a parliamentary question last year showed that the Government estimated that they would recover about £200 million a year from foreign nationals using the NHS. The hon. Lady wishes to repeal that legislation. In effect, she wants foreign nationals to come to the UK and use the NHS free of charge. No wonder she mentioned so little of that. At the end of her speech she talked about the financial crisis that the NHS is suffering, yet she is bringing forward a Bill that will stop the NHS being able to recover some of the money spent on treating foreign nationals. The whole Bill is a complete absurdity and nonsense.

If the hon. Lady is proud of that provision in the Bill, why did she not mention it during her speech? Perhaps she is secretly embarrassed about it. Perhaps she knows that her constituents would not particularly appreciate her attempt to introduce legislation to give foreign nationals free treatment, which would cost the NHS more money rather than saving it money. I know that she is one of the last remaining supporters of the Leader of the Opposition, but even he might think that that was rather a strange way of trying to improve the NHS’s financial position.

I know that this is the same Bill that the hon. Member for Brighton, Pavilion (Caroline Lucas) presented during the last Session. Perhaps the hon. Member for Wirral West did not actually read the Bill. Perhaps she presented it without having looked at it, and did not realise that it included that particular provision. Either there has been an omission on her part, or we have the rather strange absurdity that she wants to introduce legislation to take at least £200 million a year away from the NHS. She might be able to discuss how that would help the NHS, but I do not see the logic in it.

I do not intend to prevent the hon. Lady from having her moment in the sun. I merely wished to point out that the whole Bill is based on a false premise. It was the last Labour Government who introduced the private sector into the NHS, not the current Government. No matter how many times the hon. Lady repeats that particular myth, it will not get off the ground. Her Bill would cost the NHS more rather than saving it any money, and on that basis, when it comes before the House, I shall be here.

Question put (Standing Order No. 23) and agreed to.


That Margaret Greenwood, Caroline Lucas, Dawn Butler, Stella Creasy, Nic Dakin, Peter Dowd, Mike Kane, Liz McInnes, Yasmin Qureshi, Marie Rimmer, Stephen Twigg and John Pugh present the Bill.

Margaret Greenwood accordingly presented the Bill.

Bill read the First time; to be read a Second time on 4 November 2016 and to be printed (Bill 51).

On a point of order, Mr Speaker. During a debate on 13 June, I raised the issue of British taxpayers’ money being used to fund convicted Palestinian terrorists. I twice requested that the Minister of State, Department for International Development, publish the memorandum of understanding between DFID and the Palestinian Authority. The Minister has now written an extraordinary letter to me, saying that his officials are seeking a meeting with the Palestinian Authority to discuss the release of the document. The Palestinian Authority is being given the right to veto a Member of Parliament’s request for information. How are we supposed to hold the Government to account when they refuse to release crucial documentation unless they are given permission to do so by the Palestinian Authority?

It sounds a rum business, I am bound to say, but it is not a matter for the Chair. It is a matter that will have to be pursued with a terrier-like tenacity, and knowing the hon. Gentleman—as I have done for 30 years, since our robust skirmishes in the students’ union of the University of Essex—I can testify to his possession of that quality in a high degree. I therefore rather imagine that he will pursue the matter until he gets what he wants.

Independent Parliamentary Standards Authority

Motion made, and Question put forthwith (Order, 30 June, and Standing Order 118(6)),

That an humble Address be presented to Her Majesty, praying that Her Majesty will appoint Jenny Willott to the office of ordinary member of the Independent Parliamentary Standards Authority with effect from 7 August 2016 for the period ending 31 December 2020.—(Margot James.)