(13 years, 1 month ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
18:55 - The House divided: - Ayes: 224 / Noes: 305 - Question accordingly negatived.
Madam Deputy Speaker (Dawn Primarolo)
I advise the House that neither of the amendments has been selected by Mr Speaker. I remind Members that there is a six-minute limit on Back-Bench contributions, and I am sure that when making their opening speeches, both Front-Bench speakers will be conscious of the number of Back Benchers who want to speak in the debate.
John Healey (Wentworth and Dearne) (Lab)
I beg to move,
That this House supports the founding principles of the National Health Service (NHS); therefore welcomes the improvements patients have seen in the NHS and supports steps further to ensure the NHS is genuinely centred on patients and carers, achieves quality and outcomes that are among the best in the world, refuses to tolerate unsafe care, involves clinicians in decision-making and enables healthcare providers to innovate, improves transparency and accountability, is more efficient and gives citizens greater say; recognises however that all of those policies and aspirations can be achieved without adopting the damaging and unjustified market-based reorganisation that is proposed, and already being implemented, by the Government; notes the strength of concerns being raised by independent experts, patient groups and professional bodies about the Government’s NHS reorganisation; further notes the similar concerns expressed by the Liberal Democrat Party spring conference; and therefore urges the Government to halt the implementation of the reorganisation and pause the progress of the legislation in order to re-think their plans and honour the Prime Minister’s promise to protect the NHS.
We have called this debate because of the growing crisis of confidence in the Government’s handling of the health service and the Conservatives’ NHS reorganisation, and a growing lack of confidence among independent experts, professional bodies and patients groups. Only one in four of the public back giving profit-making companies free access to the NHS, two thirds of doctors think the reorganisation will lead to worse, not better, patient services, and nearly nine in 10 believe it will lead to the fragmentation of services. When the Prime Minister misquotes me at Prime Minister’s Question Time in support of his plans, we know he is desperate and increasingly isolated.
John Healey
I will give way shortly.
Yesterday the British Medical Association delivered a comprehensive vote of no confidence in the Government’s plans. Dr Hamish Meldrum, the BMA chair, said they were
“driven by ideology rather than evidence, enshrined in ill-thought-through legislation and implemented in a rush during a major economic downturn.”
On Saturday the Lib Dems did the same. Baroness Williams called the plans “lousy” and a “stealth privatisation”. I heard that very good speech for myself at the conference in Sheffield, and I hope that today the House will hear speeches by the hon. Members for Southport (John Pugh) and for St Ives (Andrew George) similar to those that they made to their party conference on Saturday. I must also say to the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), that I hope that when he winds up this debate we do not hear the same flat and feeble apology that he gave for the Government’s plans when he opened the conference debate. He was totally rejected by his party, which told him and his parliamentary colleagues that the Health and Social Care Bill must be amended.
John Healey
I will give way in a moment.
The test for the Prime Minister is whether the Government’s proposals are always under review, as the Health Secretary said on Sunday, or whether this is not about significant changes to the policy, but about reassuring people as the Bill goes through the House, as people in the Department said on behalf of the Health Secretary on Monday.
Mark Pritchard (The Wrekin) (Con)
Does the right hon. Gentleman not accept that with an annual budget of £100 billion and rising, there is room for efficiency savings and reform? Why has he set his face against fundamental reform, which even the public accept needs to take place?
John Healey
Nobody can doubt our commitment to the NHS, and to both investment and reform, during our 13 years in office—often in the face of opposition from trade unions. Of course there is room for efficiencies, and there are ways to get much better value for money out of the NHS but, as the Select Committee on Health has said, the reforms will make it harder, not easier, to meet that challenge.
Rehman Chishti (Gillingham and Rainham) (Con)
Has the shadow Health Secretary seen the consultation responses to the White Paper, which show widespread support for the reforms?
John Healey
The hon. Gentleman needs to read some of the material for himself, rather than just reading the briefings provided by his Whips and his Front-Bench team. Some of the 52 organisations that this Government and the Health Secretary claim supported the Bill have written to me saying that far from supporting the principles of the Bill, they have “grave concerns” about the White Paper; that was said by the Patients Association. The Chartered Society of Physiotherapy has said:
“We have been very clear that we have grave concerns about the scope and speed of the structural changes proposed”.
Diabetes UK, Cancer Research UK, the Royal College of Speech and Language Therapists and others do not take kindly to being misrepresented by Ministers as supporting this Bill when they have such grave concerns.
Mr David Evennett (Bexleyheath and Crayford) (Con)
I always thought that the right hon. Gentleman was a reformer at heart, but he obviously is not, given what he is saying today. Why did productivity in our hospitals decline by 15% during the 13 years of the Labour Government, while bureaucracy increased?
John Healey
One of the problems—we all know this, and the new Government will be faced with it in exactly the same way—is exactly how to measure productivity in the NHS. Given the complexity of what is provided for patients—and the requirement to put together packages of care to help people recover from serious illness and live independently is so complex—it is hard to do that. The NHS just is not like a commercial business, which is what this Government want to turn it into.
Henry Smith (Crawley) (Con)
Let us consider something more quantifiable. Is the right hon. Gentleman in favour of more or less bureaucracy in the NHS?
John Healey
Let me send the hon. Gentleman a copy of the Labour manifesto, because we set out exactly how we could make significant savings from the bureaucracy.
John Healey
I am just responding to the hon. Gentleman’s colleague, so I ask him to be patient. We set out exactly how we could reduce the costs and some of the bureaucracy. Perhaps the hon. Member for Crawley (Henry Smith) could ask his Front-Bench colleagues how bureaucracy will be cut when the function currently carried out by 150 primary care trusts in England will be carried out instead by more than double that number of general practitioner consortia.
Grahame M. Morris (Easington) (Lab)
Perhaps the Secretary of State, too, would share his thoughts about how money will be saved on bureaucracy when expenditure on Monitor, which will take on a new economic regulator role under clause 52 of the Health and Social Care Bill, will increase from £21 million a year under Labour to as much as £140 million a year—£500 million over the course of a Parliament. How is that saving money on bureaucracy?
John Healey
My hon. Friend does a great job in ensuring that this Government are held to account on the NHS through the Health Committee. He rightly says that Monitor’s budget is currently about £20 million and the impact assessment calculates that that could increase to as much as nearly £140 million—although Monitor’s core operating costs are not that entire total, the figure will be at least three times as high as it is now. That is not a decrease in bureaucracy and operating costs, it is an increase. Hon. Members would do well to read some of the documents, rather than the briefings they have been given by their Front Benchers.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
My hon. Friend the Member for Easington (Grahame M. Morris) has told us that Monitor’s budget will increase by the amount that he said, but does my right hon. Friend agree that it will continue to increase exponentially, because the Government are opening up the NHS to European competition law, and that competition will grow exponentially year on year?
John Healey
This is such a big and fundamental change to the NHS that £140 million is the best guess. Clearly, as the competition role of Monitor increases and the competition legislation it has to deal with becomes stronger, those costs could increase. We simply do not know, because this is a leap in the dark for the NHS.
Simon Hughes (Bermondsey and Old Southwark) (LD)
Having listened to the debate at our party conference on Saturday, the right hon. Gentleman will know that there were strong views that the Bill needed to be further improved and strengthened, but he will also know that there was no call for it to be pulled or paused. He will also remember that when his party and my party joined together to form the NHS, the doctors were not always on the side of the enlightened.
John Healey
The Liberal Democrats are quick to try to claim credit for other people’s successes, and quick to try to duck responsibility for some of the difficult challenges they face. However, the right hon. Gentleman is right—it was the BMA that called yesterday for the Bill to be withdrawn. Our motion calls not for it to be withdrawn but for a pause in its passage through Parliament to give the Government a chance to rethink, exactly as was requested by speaker after speaker at his conference in Sheffield on Saturday, and all but a handful of the members who voted at it.
John Healey
I am going to make some progress. We are all conscious of your encouragement to do that, Madam Deputy Speaker.
Some say that the Prime Minister and the Health Secretary are failing to get the message across, but from the start they have told only half the story. The Tories did not tell people about their plans for reorganisation and market competition at the heart of the NHS before the election, and they did not tell the Lib Dems about them before they signed the coalition agreement pledging that there would be no NHS reorganisation. There is no mandate from the election or the coalition agreement for this fundamental reorganisation and far-reaching legislation. They will not be straight with people about their plans. This is not just about communication; it is about judgment. In the face of widespread warnings, they are forcing through at breakneck speed the biggest reorganisation in the NHS’s history.
Nadhim Zahawi (Stratford-on-Avon) (Con)
The right hon. Gentleman wisely started by saying that there is room for reform. The right hon. Member for Edinburgh South West (Mr Darling) had plans in his Budget for a 20% cut in the NHS. Will the shadow Secretary tell us which bit of the NHS he would cut to deliver that 20%?
John Healey
There is someone else who needs a copy of the Labour manifesto. He almost used his six minutes’ allocation to make that intervention.
John Healey
I am going to move on. If that is the best the Conservatives can do, I am going to move on.
The truth is that the more people see of the plans, the less they like them. The closer they look the more concerned they become, because they start to see far-reaching changes at the very heart of this reorganisation and legislation. These are the wrong reforms for the wrong reasons at the wrong time. As our motion says, and as the Lib Dem conference motion said, most people would agree on the declared and desirable objectives—indeed, that is the direction in which the Labour Government were heading—but those aims could be better achieved without this huge internal reorganisation and, as the Lib Dem conference motion stated,
“without adopting the damaging and unjustified market-based approach that is proposed.”
Steve McCabe (Birmingham, Selly Oak) (Lab)
Does my right hon. Friend agree that there is room for reform, but not room to risk the GP-patient relationship? Dr Gerada and the Manchester business school have both highlighted that there is a risk that bonuses and profits could be put above diagnoses and treatment.
John Healey
My hon. Friend is right: this reorganisation and legislation leave no part of the NHS untouched. One big concern is that when GPs are making both rationing and referral decisions at the same time, patients will start to ask whether their GP is making a judgment about their treatment in their best interests or in the best interests of his or her budget and consortia business. That can hit at the trust at the heart of the patient-doctor relationship.
Sajid Javid (Bromsgrove) (Con)
I thank the right hon. Gentleman for giving way so generously. He has mentioned the Labour manifesto twice, and I just happen to have a copy of it. It says that Labour will support a
“role for the independent sector”,
encourage any willing provider, make all hospitals foundation trusts and give them the
“freedom to…increase their private services”.
On that basis, will he explain why he and the leader of the Labour party, who I believe to have been the author of that manifesto, are reneging on that position?
John Healey
We were doing what the manifesto said before the election. [Interruption.] We were doing it where the private sector and competition could add capacity to clear waiting lists, or do something new that the NHS was not doing. We did it in circumstances that were carefully planned, properly managed and always publicly accountable. If the hon. Gentleman is going to swallow the guff from those on his Front Bench that this is somehow an evolution of Labour’s policy, he will have to ask the Health Secretary why he needs legislation that is more than three times longer than the Act that set up the NHS in the first place.
Why do we say what we do in the motion before the House? In truth, this is a Tory reorganisation, and the legislation has been mis-sold. It is not just about getting GPs to lead commissioning or looking to cut layers of management; it is setting up the NHS as a full-scale market driven by the power of the competition regulator and the force of competition law. The reorganisation and legislation is designed to break up the NHS, open up all areas of the NHS to private health companies, 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. The Tories are driving the free market political ideology through the heart of the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On precisely that point about scrutiny and accountability, we have been talking about independent sector providers. Under Labour, if scrutiny committees in local authorities wanted to investigate the activities of independent sector providers they could not do so. Under our legislation, they will be allowed to do so. Wherever NHS money—the public pound—goes, scrutiny will be able to follow. That is a change for the better.
John Healey
That is simply not true. The people who will make the big decisions about £80 billion of spending—the GP consortia—will not need to meet in public or to publish minutes of their meetings. They will not be subject to scrutiny by this House or proper public accountability.
Let me turn now to the question of subjecting the NHS to UK and European competition law. The Prime Minister clearly did not know about that at Prime Minister’s questions today—he clearly did not know that a third of his legislation sets up this new free market NHS. Perhaps the Health Secretary has only told him half the story about the legislation—
John Healey
Shall I finish what I have to say? Then I will give way. If the Health Secretary has not told the Prime Minister, he certainly has not told the public or this House, so let me spell it out—[Interruption.] The Health Secretary says that I have made it up, but why not wait for me to explain to the House, and then he can say whether what I am about to explain to the House is in my words or his?
Clause 52 of the Health and Social Care Bill, entitled “General duties”, sets up the new competition regulator, Monitor, and says:
“The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services—
(a) by promoting competition where appropriate, and
(b) through regulation where necessary.”
The new regulator is given legal competition powers, as well as functions under the Competition Act 1998 and the Enterprise Act 2002, and there are provisions on reviews by the Competition Commission and co-operation with the Office of Fair Trading.
John Healey
The Secretary of State can speak in a minute; I will finish this point. The regulator can investigate complaints about competition, force services to be put out to competitive tender, remove licences and fine the commissioner or provider up to 10% of their turnover. Helpfully, the Government’s new chair of Monitor confirms that. In The Times last month, he said:
“We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation”.
Mr Lansley
It is dead simple: the Health and Social Care Bill does not extend the application of EU competition law, or the application of domestic competition law. The powers given to Monitor as a sector regulator are the same as those now available to the Office of Fair Trading. The Bill does not change the scope of competition law at all.
John Healey
The right hon. Gentleman was involved, so he knows better than anyone else that the Tories are now setting out to do to the public services, including the NHS, what they did to the public utilities in the 1980s.
John Healey
Let me finish. The Government’s explanatory memorandum is helpful on the issue of EU law. It says, about chapters 1 and 2 of the Bill—the one third of the legislation that sets up the new competition system—that
“The Chapter 1 and Chapter 2 prohibitions are modelled on Articles 101 and 102 of the Treaty on the Functioning of the European Union which prohibit agreements that prevent, restrict or distort competition, and abuse of a dominant market position.
Monitor would have concurrent powers with the OFT to conduct investigations where it had reasonable grounds for suspecting that either of these two prohibitions—under either UK or EU law—had been infringed in the provision of health services in England.”
That means that a competition challenge in the NHS can be taken all the way to the European Court.
Helpfully, under pressure in Committee yesterday, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), confirmed that
“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
As GP consortia will be corporate bodies, not public sector bodies, and as hospitals will be competing with each other, will have no limit on treating private patients, and will have no support from the wider NHS if they run into financial problems, they will be bodies to which the EU competition rules and legislation apply. That means that the NHS will be tied up in the red tape of market regulation and competition law, and we risk decisions about who provides our health care services being taken not in England by GPs or Ministers, but in Brussels by the European Commission, and in Luxembourg by the European Court.
Margot James (Stourbridge) (Con)
The right hon. Gentleman has already acknowledged that competition and markets were a hallmark of the Labour Government; they took them far further than the previous Conservative Government ever did. Of 475 acute care sites providing elective care, 175 are independent sector providers. The Bill proposes making the competition fair and putting it on a level playing field. No longer will we allow the private sector to be as favoured as it was under the Labour Government.
John Healey
This is a debate. People in the country and in the NHS are worried not about what we did in government—they saw the massive improvements under Labour—but about the application of competition law, domestic and European, in full force to the NHS for the first time. The hon. Lady is serving on the Public Bill Committee. She will have the chance to get her head around that, as she clearly has not done so yet.
Owen Smith (Pontypridd) (Lab)
My right hon. Friend has anticipated the point that I was going to make. As we heard clearly in Committee yesterday—the Secretary of State ought to read the Official Report—his Minister, the right hon. Member for Chelmsford (Mr Burns), let the cat out of the bag. Hitherto the NHS has been insulated from European competition law. As there are more entrants to the market, competition law will have to apply—competition red in tooth and claw—followed by the break-up of the NHS.
John Healey
My hon. Friend is right. We have misinformation and confusion. If the Health Secretary disagrees with his Health Minister, I suggest that they have a word about it after the debate.
In the end, perhaps Nye Bevan was right. When Clement Attlee suggested that the NHS opening should be celebrated as a national institution supported by the whole nation, he said, “The Conservatives voted against the National Health Act, not only on second but the third reading. . . I don’t see why we should forget this.”
It is time for the Health Secretary to tell us why he is spending £2 billion on an NHS reorganisation when front-line staff and services are being cut. How many hospitals will be forced to close because of these reforms? Why is he handing such powers over our NHS to new national quangos, competition lawyers and the EU? Why is there no democratic voice in commissioning? Why is he allowing profit to be made in commissioning essential health services? Why is he removing any limit on private patients paying to jump the queue for treatment in NHS hospitals?
John Healey
It is time the Health Secretary told us who is fully in support of the NHS reorganisation and the legislation. NHS staff, dedicated to the part that they play in our NHS, will strive to keep things going whatever the pressures, but patients are starting to see operations cancelled, waiting times rise, hospital services at risk, front-line staff jobs cut and services cut. This is not what people expected when the Prime Minister said that he would “protect the NHS”. Instead, they are seeing the Prime Minister’s NHS promises to “protect front-line services”, to “give the NHS a real rise in funding”, and to “stop top-down reorganisations that get in the way of patient care” all broken. The NHS was the Prime Minister’s most personal pledge. It is now becoming his biggest broken promise.
Now is the time to listen to the chorus of criticism and concern, and to recognise the growing crisis of confidence in the Government’s handling of the health service. Now is the time to call a time out, pause the passage of the Bill in Parliament, and think again. I commend the motion to the House.
The Secretary of State for Health (Mr Andrew Lansley)
The Labour motion is interesting. I will ask the House to reject it, but it is an interesting motion. The first half of it accepts the principles of our reforms—it even does so in the same terms in which we have expressed them—but in the second half it goes on to say, “Not yet. Don’t make us do it yet.” Labour Members are turning their backs on the change that we need in the national health service and even on the policies they pursued in government.
But it is time for change. The public agree—65% of adults in England think that fundamental changes are needed in the national health service. The need to improve results for patients demands it. The need to empower clinical leadership demands it. The need to cut bureaucracy and invest in front-line care for patients demands it. As a coalition Government, we do not shirk our responsibilities. We have been absolutely clear that the NHS will remain free at the point of need, paid for from general taxation and based entirely on need and not on the ability to pay.
Those values are not, and never will be, threatened by this Government. The Health and Social Care Bill will not undermine any of the rights in the NHS constitution. It is for those same reasons that we, in a coalition Government, are protecting the NHS in the life of this Parliament by increasing NHS funding by £10.7 billion.
Clive Efford (Eltham) (Lab)
Will the Secretary of State distance himself from the comments of Dr Charles Alessi, a GP alleged to have been one of the architects of GP commissioning in this Bill and one of the people invited to No. 10, who is of the opinion that too many people in his area are receiving treatment for macular degeneration? Is that not rationing services and nothing whatsoever to do with providing them on the basis of clinical need?
Mr Lansley
All GPs and their colleagues who were part of the first wave of pathfinders were invited to No. 10—there were far more than we ever expected—and Charles Alessi was one of them. It is a complete illustration. I do not know what Charles said or why he said it, but he is the doctor, not me. Frankly, I think that it is clinical leaders in the NHS who are responsible for what they say, not me.
Nadhim Zahawi
Does my right hon. Friend agree that the way in which the Opposition are conducting themselves, when they proposed a 20% cut to the NHS, is scaremongering among our constituents and entirely irresponsible?
Mr Lansley
My hon. Friend makes an extremely good point, and he made it to the shadow Secretary of State, who did not answer it.
Mr Lansley
No.
The fact is terribly clear that before the election the Labour Government said that in three years the NHS would have to save between £15 billion and £20 billion. The Labour party never said in government that that money, if saved in the NHS, would be reinvested in the NHS. The other point is that when we came to the spending review, in which we agreed £10.7 billion extra for the NHS over the life of this Parliament, the shadow Secretary of State’s friends, who were then responsible, said that we should cut the NHS. We do not need to speculate about what they said they would do, because we can look at the example of Wales. The Labour-led Welsh Assembly Government are proposing to cut the NHS budget in Wales by 5%, while we are increasing it. We know exactly what Labour would do if they were in charge of the NHS: they would cut it. We have not cut it and are going to protect it.
Simon Hughes
I share absolutely my right hon. Friend’s view that the protection of the budget and the commitment to the principles of the NHS, which he has just enunciated, are really valuable and that Labour’s record in forcing privatisation undermines its whole argument. He knows that there are concerns. Having come back from the debate in my party, I ask him straightforwardly whether he will take on board the concerns expressed and look at ways to strengthen and further improve the Bill as it passes though this House and the House of Lords.
Mr Lansley
My right hon. Friend was busy in Sheffield over the weekend, but he might have heard me say on Sunday that where there are legitimate concerns, founded in reality rather than myth, about how we will secure the NHS and its modernisation for the future, we will listen. We have listened and changed the policy before the Bill was introduced. We have already amended the Bill during the course of its passage so far and will always look to clarify and improve it as it proceeds.
Mr Lansley
I will give way to the hon. Gentleman, and perhaps he can explain why the Labour party leading the Welsh Assembly Government will cut the NHS by 5% while we are going to increase the budget by £10.7 billion.
Michael Dugher
I might be new to Parliament, but we ask the questions and he is supposed to answer them. The Secretary of State knows full well that patient groups, health charities, doctors and nurses oppose the Bill—even that shower opposite opposed it at their conference. Is it not just arrogance on the part of the Government—
Madam Deputy Speaker (Dawn Primarolo)
Order. The hon. Gentleman needs to moderate his language. I would grateful if he withdrew the word “shower” and thought of another way to make his point that uses parliamentary language.
Michael Dugher
I withdraw “shower”.
Is it not just arrogant for the Government to think that everybody else is wrong and they are right—
Madam Deputy Speaker
Order. It was not an opportunity to ask another question, either.
Mr Lansley
The hon. Gentleman has now learned that, if one is trying to pray somebody in aid, it is best not to insult them at the same time.
We have made it clear that we need to protect the NHS now and for future generations through modernisation. Under the Labour party—
Mr Lansley
Ah! Now we really do have somebody who can explain why in Wales the Labour party is cutting the NHS budget while we are increasing it. Come on!
Owen Smith
That is happening as a result of the very difficult decisions being taken in Wales, having seen the Welsh Assembly budget cut by £1.8 billion by the right hon. Gentleman’s Government. What we are not doing in Wales, however, is effectively privatising the NHS, exposing it to competition law or stuffing the mouths of private companies with public gold.
Mr Lansley
Let us remember that, when we decided to support the NHS here, through the Barnett formula by extension, money was provided to the devolved Administrations, but the hon. Gentleman confirms that a Labour-led Welsh Assembly Government chose not to invest in the NHS, while we in England chose to do so. I urge Welsh voters to remember that when they come to the elections in May.
Under the trade union thumb, Labour is turning its back on modernisation in the NHS, but the NHS cannot be preserved for the future and protected by neglect; it is not something that sits in a static format. It has to change to improve. When the number of managers in the NHS doubled under Labour, when results for patients in many conditions remain way below those achieved in other countries, and when the number of patients placed in mixed-sex accommodation runs into the thousands every month, the NHS needs to change.
Brandon Lewis (Great Yarmouth) (Con)
Does my right hon. Friend agree that some GPs are seeing the potential benefits to their local areas of improving the service for patients, and will he join me in congratulating GPs, such as those in Great Yarmouth, who are moving forward, several years ahead of schedule, with the pathfinder projects?
Mr Lansley
Yes. My hon. Friend will know that we have already arrived at the point where 177 GP groups, representing 35 million patients all over England, have volunteered as pathfinders to show how they can demonstrate such work. [Interruption.] Labour MPs who are insulting general practitioners might like just to remember—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Come on; we want to see the debate continue. A lot of Members want to speak and to intervene, but we cannot have so many of them on their feet at once.
Mr Lansley
I remember that if we ask the public whom they trust in public service, we find that general practitioners are at the top of the list. Members of Parliament and politicians are pretty near to the bottom of the list, so the public might take it pretty amiss that Labour politicians are insulting general practitioners by thinking that they are in it for the money. They are not; they are in it for the patients.
Kate Green (Stretford and Urmston) (Lab)
Will the right hon. Gentleman give way?
Joan Ruddock (Lewisham, Deptford) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
In a moment.
Only yesterday, the Public Accounts Committee said that over the past 10 years the productivity of NHS hospitals had been in almost continuous decline, and that taxpayers were getting less for every pound invested in the NHS: Labour, leaving us to sort out the mess. The truth of the matter is that the NHS needs to change to meet the rising demand for and cost of health care.
The changes that the NHS needs are simple: more investment, less waste, power to front-line doctors, nurses and health professionals, and to put patients first.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
Will the right hon. Gentleman give way?
Mr Lansley
No. I will give way to the right hon. Member for Lewisham, Deptford (Joan Ruddock) first.
Joan Ruddock
The right hon. Gentleman speaks of the respect that patients have for their GPs, and that is certainly the case in my area, where GPs do an incredibly difficult and demanding job. How does he think, therefore, patients and the doctors themselves regard the pressure being put on them to become managers, to adopt skills that they do not have, and being forced to do it, when they say to me that the plans are untested, potentially divisive and will take them away from their patients? Those things are actually happening. Does he think that it is ethical to pay GPs £300,000 to cut services to patients?
Mr Lansley
The Royal College of General Practitioners has said that it believes that there should be more clinician-led commissioning, and yesterday the British Medical Association reasserted its view that general practice-led commissioning is the right way forward. The Labour Government set up practice-based commissioning but, as the shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), said, GPs were not given the power, responsibility and opportunity to do it. I am afraid that the right hon. Member for Lewisham, Deptford is speaking against the evidence and the experience of GPs all over the country.
Andrew Bridgen (North West Leicestershire) (Con)
Does my right hon. Friend agree that the words of the shadow Secretary of State in this debate seem to contrast somewhat with his words back in January, when he said that
“the general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”?
Why does my right hon. Friend think he has changed his mind?
Mr Lansley
Yes, that is one possibility. Another is that Labour Members are paid for by the trade unions.
Our changes are driving real improvement. Our investment means that more than 1,300 patients are now getting the life-extending cancer drugs they need; that is investment in cancer drugs that the Labour party opposed.
Mr John Baron (Basildon and Billericay) (Con)
My right hon. Friend is absolutely right to make no apology about the need for reform when cancer outcomes in this country remain well below the European average. The all-party group on cancer and, most recently, the Public Accounts Committee have made the case for recording staging data, which provide an insight into early diagnosis. Will he assure the House that, under these reforms, the importance of this issue will be pursued by the Government?
Mr Lansley
Yes. I am grateful to my hon. Friend and pay tribute to his work in this area, which is much respected. He is absolutely right—we will be doing that. Indeed, we can see the benefit already. A few weeks ago, I launched the bowel cancer awareness campaign in the east of England. The reason we were able to start that awareness campaign in that region is that we had good staging data arising out of the cancer networks in the area, which means that we will be able to make valid comparisons between the past and the future in terms of the stage at which patients are presenting for diagnosis of cancer.
Mr Lansley
No, I have given way to the hon. Gentleman before. [Interruption.] He only gets one shot.
Let me make it very clear. Our cuts in bureaucracy—
Mr Lansley
No, I will not give way—Labour Members might like to hear this.
Our cuts in bureaucracy have led to 2,000 fewer managers since the general election and 2,500 more doctors. We are already shifting resources to the front line. More than 5,000 surgeries across the country are now part of the pathfinder groups taking responsibility for front-line services. Some 25,000 front-line NHS staff are taking the opportunity to come together in social enterprises. All this is the modernisation that Labour now opposes. It is the modernisation that is delivering the results that matter, and will matter in future even more as we get to the outcomes that people really care about—whether they live, whether they recover, whether their treatment is successful, whether they have successful lives at home with long-term conditions.
At the same time, waiting times are stable and hospital infections are down, with C. diff down by a fifth and MRSA down by more than a quarter. The number of patients who are in mixed-sex accommodation when they should not be has also come down.
Mrs Anne Main (St Albans) (Con)
Does my right hon. Friend agree that we should totally dissociate ourselves from the disgraceful remarks implying that our reforms will somehow encourage GPs to make choices that are not best for their patients?
Mr Lansley
My hon. Friend makes a very important point. I caution Labour Members not to put political opportunism in place of the relationships that they should have in future with GPs, doctors and nurses and local foundation trusts in their constituencies. They are not speaking for their constituencies—they are just speaking for the trade unions.
The coalition Government are listening to patient groups, professional bodies and independent experts. We have had eight separate substantial consultations on our proposals, and we have changed policy as a result. For example, we have amended the Health and Social Care Bill on an important point, which greatly concerned the BMA, and clarified that the measure supports competition on quality, not price. At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality. That is important.
Malcolm Wicks (Croydon North) (Lab)
Given the removal of the limit on private patients who can go to an NHS hospital, my constituents will be concerned that, in conditions of scarcity, clinical need for a bed will be trumped by the weight of a wallet. Will the Secretary of State reassure my constituents that money will not trump the needs of patients?
Mr Lansley
Yes. I can entirely reassure the right hon. Gentleman’s constituents because the Bill makes it clear that even if private patient income is available to foundation trusts, it must support the principal purpose, which is provision of services to patients through the NHS. If the right hon. Gentleman wants an example, he might like to go along the road into the constituency of the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), and meet people from the Royal Marsden, which is a foundation trust that attracts, from memory—I may not be entirely up to date—approximately 25% of income from private patients. It has consistently recorded the highest scores of excellence for its quality of service to patients.
Mr Lansley
I want to make progress. I have given way several times.
The right hon. Member for Wentworth and Dearne (John Healey) said that we planned to get rid of regional system management in the NHS, but that was Labour’s policy when it introduced NHS foundation trusts. Through introducing health and well-being boards in local authorities, we will have a genuine, system-wide view that looks at the NHS, public health and social care. He complains about the commercial insolvency regime, but Labour introduced that under the legislation that set up the foundation trusts eight years ago. He said that our plans introduce EU competition law. No. EU competition law already exists and the Bill does nothing to change that—it does not extend the application of competition law. [Interruption.] No, it does not. In Committee, the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), explained the current position, which the Bill does not change.
The right hon. Member for Wentworth and Dearne and other Labour Members talk about price competition. We have clarified the Bill to ensure that the competition is on quality. What happened under Labour? The private sector was paid 11% more than the NHS. Under Labour, private sector providers were paid £250 million for operations that they did not perform. Under Labour, NHS hospitals were barred from tendering to provide the capacity that Labour offered to the independent sector. Labour Members favoured the private sector. A Liberal Democrat manifesto commitment stated that we would not in future allow the private sector to be given advantages and the NHS to be shut out. We will implement that.
I want to know a bit, because although the right hon. Member for Wentworth and Dearne said that it was the Opposition’s job to ask questions today, I have done many Opposition day debates on health when I was asked many times what our policy was, and I answered those questions. Is it Labour’s policy to extend the use of voluntary sector providers in the NHS? That was in the Labour party’s manifesto. Indeed, Labour said that it wanted to use the independent private sector, too. Is it still the policy? No answer. We do not know. Is it Labour’s policy to make every trust an NHS foundation trust? Again, it was in the Labour party manifesto. Is it still the Labour party’s policy—yes or no? No answer. Again, we do not know. Is it Labour’s policy to promote competition in the NHS, as quoted from the Labour party manifesto in the debate? The right hon. Gentleman has just made a speech opposing that. Does he wish to intervene?
John Healey
I am grateful to the Secretary of State for giving way. We had the NHS as the preferred provider and were ready to use other providers when they could help, and we did so. The great improvements in the NHS happened because we were prepared to put in the investment and to make the reforms. The Secretary of State talks about policies. The problem with what he is doing to the NHS—the reorganisation, the legislation and the ideological change at the heart of it—is that he did not tell the people about it before the election and he did not tell the Lib Dems about it before they signed the coalition agreement. This top-down reorganisation is exactly what he promised not to do.
Mr Lansley
The right hon. Gentleman was not satisfied with his first speech, so he had to have a go at a second one. He did not answer any of my questions. The Labour party said in its manifesto that it would use the private and voluntary sectors alongside NHS providers. The reason for that was simple: having the NHS as the preferred provider meant that the patient could be let down time after time before another quality provider could be permitted. We are going to allow competition on quality, but the quality has to be there. Patients will get the best possible service from whoever is best placed to provide that care.
Our changes are being seen across the country already.
Mr Edward Leigh (Gainsborough) (Con)
This party political ding-dong is great fun, but what worries me is that we have an ageing population, there are rightly more and more expensive techniques, and the taxpayer cannot put any more money in. Who is going to save the NHS if there is no co-operation with the private sector?
Mr Lansley
Over many years as Chair of the Public Accounts Committee, my hon. Friend challenged the failure of the previous Government to secure the improvement and value for money that is necessary patients. I make no bones about it: I think that if we give NHS organisations freedom and opportunity through foundation trust status, they will be competitive. I do not think that we will see a big expansion in the number of private sector providers, because the NHS has the enterprise and innovation to succeed. However, we have to make sure that they are open to that test. We test whether voluntary and independent sector providers meet the right quality, and we must expose the NHS to that test.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The Secretary of State has decided that he is not going to give way. That is his decision. He has given way already. We need to have a little less noise so that we can hear the Secretary of State.
Mr Lansley
Thank you, Mr Deputy Speaker. I have to conclude to ensure that we do not trample on Members’ time.
We will hold the NHS to account for what it achieves, but not tell it how to achieve it. We want continuous improvements in outcomes and more personalised care. We are going to change accountability in the NHS. In the past, the only question in accident and emergency was whether people were seen within four hours. We will ask whether a patient was seen by the right person, whether the quality of care they received was appropriate, and whether they recovered. From April, we will know those things for the first time. On mental health, we will ask whether we are helping people with serious mental health problems to live longer, and whether we are helping them to get a job. We will ensure that we find out those things and that we know which services provide the right care.
Beyond the NHS, we will make changes that increase accountability. As of today, 134 local authorities with social care responsibilities—almost 90% of such local authorities in England—have signed up to be early implementers of health and well-being boards. Those are the bodies that will finally tear down the walls between the NHS, public health and social care; and they will strengthen local accountability to the public and patients. Local authorities will finally have the powers that they need to scrutinise all NHS-funded providers of care, be they public, voluntary or private sector providers.
The coalition Government were elected to protect the NHS and that is what we are doing. We are protecting the NHS in this Parliament through increased investment, and protecting it for future generations through modernisation. We need an NHS in which every system, process and incentive encourages excellence in health care and weeds out poor performance. Labour now opposes that. It has turned its back on the NHS. It wants to drag the NHS back into politics; I want the NHS to be freed from political interference so that it can deliver the best possible care and results for patients. This Government will always support the NHS. We have a simple aim: to create an NHS that is up there with the best in the world. Our modernisation plans will do just that.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I remind Members that there is a six-minute limit.
Rosie Cooper (West Lancashire) (Lab)
I have spoken in this place on several occasions about the deeply disturbing reforms that the Government are proposing to our national health service. On those occasions I have accused the Secretary of State of glibness and hubris, and as each day passes, as each new piece of information comes to light and as we scrutinise the detail of the Health and Social Care Bill, he proves my assertions right. He currently presides over what I can only describe as an unholy mess that will have huge negative consequences for the NHS and the people who love it and depend on it.
I tell the Secretary of State that the Opposition have seen through his plans, and the Liberal Democrats, who are on his side of the Chamber, see through them as well. Many of his colleagues are very nervous about them, and yesterday the British Medical Association and medical professionals made a clear and unequivocal statement that they, too, see through them. As the plans unfold further, I can tell hon. Members that patients and the British public see through them as well.
Despite the broken promises, the Secretary of State and the Prime Minister seem to think that their NHS reforms are a good idea. I am not sure that they are 100% convinced, though, given that they did not seem confident enough to share the details of their plans with the British public before the general election. In fact, the Prime Minister was very clear in his promise to the British people:
“no more pointless top-down reorganisations”
of the NHS. He even said:
“When your family relies on the NHS all of the time—day after day, night after night—you know how precious it is.”
How quickly forgotten those words were.
Some people felt reassured that, whatever else might happen if the Tories were elected, the NHS would be left untouched. How wrong they were. Today we find the NHS in a state of turmoil and facing massive reorganisation, with hundreds of health workers laid off and its very future threatened by a desire to set up a commercially driven market in health care. This very lunchtime, the Prime Minister said, “We are not reorganising the bureaucracy of the NHS. We are abolishing the bureaucracy of the NHS.” The bit he left off was that private providers would be doing that work. Who is he kidding?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Lady will have to sit down during the hon. Gentleman’s intervention.
Graham Evans
I am new to the House, but I seem to recall the right hon. Member for Leigh (Andy Burnham), who was then the Secretary of State for Health, saying that we should
“celebrate the role of the private sector in the NHS.”
What has changed for Labour Members? [Interruption.]
Graham Evans
When he was Secretary of State, the right hon. Member for Leigh said that we should be celebrating
“the role of the private sector in the NHS”.
What has changed since he made that comment?
Rosie Cooper
The health service was not an issue at the general election, and why? Because people broadly supported it and were not worried about the state that it was in. Government Members must listen to the furore that will happen and prepare to defend their seats in light of the decisions that they take now.
Rosie Cooper
No, I have very little time now.
I believe that what Michael Portillo said on the BBC’s “This Week” programme was an accurate reflection of how the Government have sought to mislead the people of this country. When asked by Andrew Neil why the Government had not told us about the plans for the NHS prior to the general election, he responded:
“Because they didn’t believe they could win the election if they told you what they were going to do. People are so wedded to the NHS. It’s the nearest we have to a national religion—a sacred cow.”
He could not have been more clear: the Government intended to misrepresent their position and to mislead voters.
As I have said previously, this Conservative Government have been prepared to play to the gallery while playing Russian roulette with the future of people’s health services. That is still the case, but the gallery is now empty. They are on their own and have no mandate—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. That is not a point of order, because the accusation was not against individual Members.
Rosie Cooper
Oh how the truth hurts! Michael Portillo could not have been more clear that the Government intended to misrepresent their position and to mislead voters.
I believe very clearly that you are playing Russian roulette with people’s futures, but the gallery is empty and you are on your own. I still believe that you have no mandate for these ill-advised reforms. You do not have that support, and it seems to me you do not have a clue—[Interruption.] It is impossible to make a speech with that noise.
I shall just recap. I do not believe that you have any mandate for these reforms. You do not have the support out there and it seems to me that you do not have a clue. For goodness’ sake, stop now before you kill the NHS.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. May I just remind Members that the Chair is not responsible? I would be pleased if we did not use the word “you”.
Mr Stephen Dorrell (Charnwood) (Con)
I serve on the Select Committee on Health with the hon. Member for West Lancashire (Rosie Cooper), which I enjoy doing. If I may say so, her speech was uncharacteristically partisan, but I guess that that is the nature of debate on the Floor of the House.
The motion moved by the right hon. Member for Wentworth and Dearne (John Healey), the shadow Health Secretary, has a clear, simple message: “Frank was right.” For 20 years, every Health Secretary—starting with my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and including me and my right hon. Friend the current Health Secretary—with the exception only of the right hon. Member for Holborn and St Pancras (Frank Dobson), has espoused the principles that underlie the Health and Social Care Bill.
The motion is an apologia from the Labour party to the right hon. Member for Holborn and St Pancras, for whom I feel rather sorry. He was roundly rubbished by his party in opposition, and now he is being canonised. As in the Roman Catholic Church, it is better that you are dead if you are to be a saint in the Labour party. I did not agree with him when he was in office, and nor do I agree with him now.
As my right hon. Friend the Secretary of State said, the truth is that the principles in the Bill are principles that every Labour Health Secretary, with the exception of the right hon. Gentleman, sought to carry out in office. Let us go through them. GP-led commissioning was one of the first principles that Labour espoused in 1997. My right hon. Friend rightly refers to practice-based commissioning, but that was actually the previous Government’s second attempt to introduce GP-led commissioning, which happened after the first attempt—primary care groups—had failed. The previous Government tried twice to apply the principle that they espoused; my right hon. Friend is trying once again.
Tom Blenkinsop
The Bill gives primacy to Monitor, which makes economic decisions. It does not give primacy to quality under the Care Quality Commission. Primacy will go to Monitor, which will make economic decisions on what health treatment people receive.
Mr Dorrell
I understand the point, and it is part of the argument that the Labour party has started to make about how, since Christmas, it has suddenly discovered that the Health and Social Care Bill and the policy that it implements—a policy based on commissioners having choices in the interests of taxpayers and patients—require commissioners to have those very choices if the policy is to be effective. As my right hon. Friend the Secretary of State said, the principle of competition for commissioners’ budgets, as funded by the taxpayer, was set out by the last Government in their policy of December 2007. Hon. Members should look at the text—it is there in the record.
The last Government were right. The right hon. Member for Wentworth and Dearne seeks to set up an Aunt Sally when he says that there is something wrong with European principles of competition law when applied to health care. Let us be clear: if we are spending £100 billion of taxpayers’ money on securing high-quality health care on the principle of equitable access, what is wrong with insisting on the principle that we should not allow monopolists to restrict the choices available for using that budget to deliver high-quality care for patients? That is the principle, and that is why I am in favour of competition law applying to the provision of health care in response to a tax-funded budget.
Nadhim Zahawi
Does my right hon. Friend agree that this is political opportunism of the worst kind?
Mr Dorrell
It is, but it is not even political opportunism that applies to a popular principle. Surely opportunism is normally motivated by some popular principle, yet defending the interests of a monopolist does not seem to me to be a very popular principle.
Mr Dorrell
I will give way to the hon. Gentleman, who is another member of the Health Committee.
Grahame M. Morris
I am doubly honoured, because the right hon. Gentleman has afforded me a courtesy that the Secretary of State would not. The concept of having greater clinical engagement—not just for GPs, but for doctors in secondary care—enjoys broad support across the parties. However, the framework laid out in the Health and Social Care Bill opens the service up to privatisation.
Mr Dorrell
I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.
Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.
Mr Dorrell
If my hon. Friend will forgive me, I will not.
There are two other important principles, one of which was espoused by the hon. Member for Leicester West (Liz Kendall) when she worked for Patricia Hewitt. That is the principle that all NHS providers should be foundation trusts, in order to provide a level playing field, and to ensure that commissioners have a fair choice and that we deliver good value, high-quality care for patients. Finally, there is the principle of “any willing provider”, where the Labour party provided us not only with a policy, but with a slogan and an election commitment to implement that policy. Now Labour wishes to desert both the policy and the slogan in its election manifesto.
This debate makes me feel as though the last 20 years never happened. It could have happened at any time between 1990 and 1997; and in fact it did—many, many times. What has happened since is that Labour in government picked up those principles and sought to put them into effect. Now, less than 12 months after the general election, it has reverted to type. It is as though nothing happened in the past 20 years. We have heard industrial quantities of nonsense this afternoon, and I hope that the House will reject the Opposition’s motion.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
This costly reorganisation of the NHS has no mandate from the British people, and no support from health professionals or, apparently, the Liberal Democrats. It will be the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health services; it also represents the values of our society by which this country sets much store. Contrary to the assertions from the Government Front Bench, the NHS reorganisation defined in the Health and Social Care Bill will wipe out the founding principles of the NHS in one fell swoop.
For the first time since the NHS was established in 1948, the Secretary of State for Health will not have a duty to provide a comprehensive health service. I will let that sink in. Instead, it is to be replaced with duties to “promote” and to
“act with a view to securing”
health services—weasel words that beggar belief. The original duty is fundamental to protecting the provision of a universal, comprehensive health service. It is the foundation on which the NHS was established. Without it, we will no longer be sure that a comprehensive national health service will be provided, and Members of Parliament will no longer be able to hold the Secretary of State to account on behalf of the constituents who elected them.
Rather embarrassingly for the Secretary of State, he might recall that, when he presented evidence to the Health and Social Care Bill Committee, I questioned him on this and asked him why he was repealing that fundamental duty. He said that he was not. However, it is absolutely clear from the Bill’s explanatory notes that that is exactly what will happen. Paragraph 64 states that clause 1
“removes the current duty on the Secretary of State in subsection (2) of section 1 to provide or secure the provision of services for the purposes of the health service.”
That duty is absolutely core: the NHS was established to provide a universal, comprehensive health service, but that will soon be gone. It is worrying that the Secretary of State did not appear to understand the implications of competition law, or to know what was being repealed in his own Bill.
The Government have suggested that these functions will now be the duty of the NHS commissioning board and the GP consortia, but the exercise of the functions will be discretionary. There will be no requirement to provide those services. So I repeat that the Bill will take away the duty to provide a comprehensive, universal health service.
Debbie Abrahams
No, I am sorry, I am going to make progress so that everyone gets a chance to speak.
The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.
Debbie Abrahams
No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]
Debbie Abrahams
Not only are the founding principles of the NHS in danger of being wiped out, but its culture—the reason that most of its employees work for the NHS—will go as well. The whole ethos of the NHS will change. It will now be driven by competition and consumer interests—[Interruption.]
Debbie Abrahams
My first question to the Secretary of State was about the proposal that the NHS commissioning board will be able to award bonuses to the GP consortia that it deems to be adopting innovative measures. The Bill states:
“The Board may make payments as prizes to promote innovation in the provision of health services.”
That means bonuses within the NHS based on innovation, which is anathema to the NHS and not what we want for it. This is indicative of the Bill as a whole. Central to the reforms are increasing competition across the NHS and opening it up to providers from the private and voluntary sectors. The Government claim that increasing competition drives down costs and improves quality, but there is evidence from across the world—in the US and Europe—that that is not the case. It does not improve quality at all in health care systems.
Although I am glad to see that the Government have reversed their position on price competition, as of yesterday they were still wedded to establishing Monitor as a powerful economic regulator with the duty to promote competition. As has been pointed out, our health services will be subject to EU competition law for the first time. By forcing these GP consortia to put any services out to competitive tender—even if they are working well and patients and the public are happy with them—the Bill encourages “any willing provider” to—
John Pugh (Southport) (LD)
I am glad to be called to speak. I had a hand in drafting both amendments and the motion in that it is taken from the Liberal Democrat conference. I appear to be responsible for the lot, so I may be a parliamentary first.
I begin by stating the blindingly obvious: the Health and Social Care Bill is in trouble. There is hostility to it from the professions, anxiety about it among the public, concern in the Cabinet and an unease that can be felt spreading in all sections and all parties in this House and the other place. That is just a fact, and it matters more than the political knockabout here or any loss of face, because the effects of the policy—for good or ill, for better or worse—announced with unseemly and misguided haste last June are going to be felt in every home in the country.
Nadine Dorries
I thank the hon. Gentleman for having the good grace to give way. Would he describe the 5,000 GPs who agreed to be part of the pathfinder consortia as “uneasy”? It appears to me that they are incredibly enthusiastic to get going.
John Pugh
I think it is Hobson’s choice.
This is not the first health reform—the last Government introduced more “step changes” than could fill an episode of “Strictly Come Dancing”—but it is certainly the biggest, the most expensive and possibly the most risky. The Secretary of State seems to have chosen for himself a path on which future generations will either put up statues to him or burn him in effigy. However, it is no longer his Bill; it is our Bill. No Secretary of State currently commands a majority in this House.
This Parliament may act like all the others hitherto—and, sadly, it usually does, as it has largely done today—but it is not like any other Parliament. There is no party in this House with a majority, so we should dump the tribalism, the point scoring and the political games. We can get round to doing what we have to do and what we need to do. We have the chance to scrutinise, to seek to amend and improve—and, if unsatisfied, the chance to reject the Bill on Third Reading. That applies to Members of all parties. It is not just “top-down reorganisation” of the health service that we should have dropped with the coalition; we should have dropped “top-down legislation”, whereby MPs simply become pawns in a wider political game, and conviction takes second place to coercion.
There has never been a Secretary of State who has looked at the NHS and found it to be perfect and incapable of improvement. That is largely because we demand so many incompatible things of it that any incarnation is unlikely to satisfy all. Each successive Secretary of State suggests proposals for reform, rather like the Flying Dutchman in a hopeless and sadly doomed pursuit of the ideal format for the NHS. I have to say that the current Secretary of State is probably better equipped for this eternal task than any others: he is committed, passionate, well informed—probably the best informed Secretary of State we have had for some time—and he is brave. He voyages on, undeterred by the siren voices of think-tanks from right and left and the warnings about costs and practical difficulties, and unfazed by the lack of enthusiasm, if the polls are to be believed, among the NHS crew and staff. Of course, as a Liberal Democrat I am disinclined to believe polls at the moment. He carries on, unmindful of the uncharted nature of the course he has set. In Committee, we found real gaps in the understanding of how things will proceed. It is not that he is unaware of the possible danger, but the big danger is that any potential shipwreck will cause us all to be engulfed if costs overrun, if productivity falls, if hospitals close, if waiting lists grow, if morale declines, or if the NHS appears to be denatured, privatised, and not safe in our hands. That is why Parliament’s role is so important in this context, and why good argument rather than the Government machine must prevail.
Greg Mulholland (Leeds North West) (LD)
I pay tribute to the work that my hon. Friend is doing on the Bill. Does he agree that, as with the forestry decision, the coalition shows its strength when it actually listens to the concerns that are out there, and is that not exactly what we need the Government to do at this stage?
John Pugh
Indeed. In the circumstances that my hon. Friend cites, both coalition parties listened to the voices that they heard and took serious note of them.
It would be unsafe to draw any conclusions from the voting patterns today. Political gamesmanship and party loyalties will prevail. However, it is not necessary to hang around the Lobbies much to see that a corrosive unease is spreading through Government ranks, even in the most unlikely quarters, and to see how opposition hardens with every defiant, unbending rebuttal from the Richmond house bunker. We must accept that the Committee, for all its forensic talent, will not solve the problem; we must concentrate on Report and Third Reading, and on the debates that will take place offstage beforehand.
This is our Bill, not the Secretary of State’s. It will not come about unless we vote for it. Even the most calculating, the most tribal, the most ambitious of us—but not, possibly, the most stupid—must see the clear risks as well as recognising the opportunities. If we get it right, reform can take place with the grain of professional and expert opinion, without Ministers’ ceasing to be ambitious for the NHS, and with broad political support in the House and in the country, and arguably it will work better as a result. However, it will require dialogue.
It is a profound irony that the Government want to abolish what they call the command and control model of the NHS by means of a command and control model of legislation. Indeed, they issued a Command Paper over the Christmas period, but then Richmond house does not do irony. If Parliament is to help the Government to climb out of the hole into which they threw themselves last June when the White Paper announced the liberation of the NHS, we need genuinely constructive, open dialogue, and we need it to start here. Perhaps, in order to liberate the NHS, we need to liberate Parliament a little bit first.
Karl Turner (Kingston upon Hull East) (Lab)
It is a privilege to follow the hon. Member for Southport (John Pugh). Like him, I am a member of the Public Bill Committee considering the Health and Social Care Bill, and I always listen intently to his well-informed and reasoned speeches. I think that many Opposition Members, at least, will agree with what he has said today.
The Government’s proposed changes will fundamentally alter the nature of the health care system for the worse. That opinion is held not only by Opposition Members but by numerous experts, including the British Medical Association, the Royal College of Nursing and the Royal College of Surgeons, to name but a few. I am pleased to say that we now know that the Liberal Democrats agree with us on this issue, but it is not enough for them to talk tough. They must do what they say they can do. They should not just sit on the fence. They have a real opportunity to prove to the electorate that they can change Government policy when it is damaging and destructive to their constituents.
The damage that this policy will do is, in my view, irrevocable. Let us make no mistake: the Government are ripping the N from the NHS. They are planning, by stealth, a wholesale change in the structure of our health service system. The plans are damaging and, without question, revolutionary rather than evolutionary.
Karl Turner
Not at the moment.
The Government Front-Bench team and its Lib Dem colleagues can argue against what I say until they are blue in the face, but we know what the reality is. The chief executive of the NHS, Sir David Nicholson, says:
“The scale of the change is enormous—beyond anything that anybody from the public or private sector has witnessed”.
When we bear in mind the context of the plans, the destruction to the NHS becomes very apparent. The plans are to be implemented at a time when the NHS is to make £20 billion in efficiency savings. This is a costly, unnecessary and reckless top-down reorganisation of the NHS, and it is without any real mandate. The coalition agreement clearly states that the new Government will stop the top-down reorganisation of the NHS. Instead, we are faced with a reorganisation that is described as being so big
“you can see it from space.”
Christopher Pincher (Tamworth) (Con)
The hon. Gentleman seems to favour top-down organisation of the NHS. Does he agree with his party’s shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who said:
“Many staff are disillusioned and disempowered by the top-down target driven approach that has dominated much of the last decade of health policy”—
his party’s policy?
Karl Turner
I am well aware of my hon. Friend’s remarks, and they were made in a very different context, but let us listen to the BMA. Yesterday, it held its first extraordinary meeting for 20 years. Interestingly, it has convened two emergency meetings in the past 20 years, both of them under a Tory Government. It is the same old Tory story: they cannot be trusted with the NHS.
The most damaging part of these plans is the competition aspect. The Secretary of State’s smokescreen about GP commissioning is designed simply to divert attention from the underlying plans, which are, as Baroness Williams has said, privatisation by stealth, and Professor Ham of the King’s Fund correctly asserts that the commissioning reforms
“are of secondary importance compared with the radical extension of competition”.
The Health and Social Care Bill brings the NHS within the remit of competition law for the first time, and Monitor, the new economic regulator, will be instructed actively to promote competition under clause 52. Placing a statutory obligation on Monitor to enforce competition creates a situation in which commissioners will not be able to act in the best interests of their patients, for fear of a costly legal challenge lurking in the shadows.
The Government’s approach to Monitor demonstrates how ill thought out these plans are. In a clamour to roll back the state and win favour with the private health companies that have bankrolled their party, the Government’s plans to introduce competition into the NHS will work against the integrated networks needed to ensure that the long-term ill receive the services they need and are entitled to.
The most worrying aspect of this policy is that the Government have ignored expert criticism—or, indeed, criticism of any kind. The divide is pretty stark. On one side there is the BMA, A National Voice, the Royal College of Nursing, the Stroke Association, the Royal College of Surgeons, the Chartered Society of Physiotherapy, the Royal Pharmaceutical Society, the Foundation Trust Network, the Royal Society of GPs, and, since the weekend, the Lib Dems. On the other side, there is the Secretary of State and the private health companies, who are bound to be rubbing their hands, waiting expectantly for their investment in him and his party to pay off.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a great pleasure to speak after the great tour de force that we heard from my right hon. Friend the Member for Charnwood (Mr Dorrell). He dispelled a huge number of the myths that the Opposition have been trying to put forward today and during our entire Committee proceedings on the Health and Social Care Bill—one would almost believe that they had not been in power for the past 13 years. It is clear that one of the main reasons why we need to reform the NHS is not just to build on what the previous Government have done in terms of using private sector providers, but to make sure that we put a lot of things right. We are cutting bureaucracy and putting more money into front-line care—that is one of the main purposes of the Bill.
Before I develop my arguments about bureaucracy, I wish to pick up on what my hon. Friend the Member for Gainsborough (Mr Leigh) said in his intervention. He talked about the challenges of dealing with an ageing population. This country undoubtedly faces a big problem in providing health care as a result of many people living a lot longer, although that is a good thing. A lot of people have multiple medical comorbidities as they get older and they need to be looked after properly. The key financial challenge to the NHS is in ensuring that we look after our ageing population, and properly resource and fund their care, so when we cut bureaucracy and put more money into front-line patient care, that is what that is about.
When we talk about the need to ensure that the NHS has local health care and well-being boards—an NHS that is more responsive to local health care needs—it is a response to the fact that some parts of the country, such as, Eastbourne or my county of Suffolk, have an increasing older population, who need to be properly looked after in terms of funding. That is why it is so important that this Government have committed £1 billion to adult social care and are increasing that. It is also why we are putting an extra £10 billion into the NHS budget over the lifetime of this Parliament—the Labour party would not have done that.
On bureaucracy, it is worth reminding the Labour party of a few things it did when it was in power. Under Labour the number of managers in the NHS doubled. In 1999, there were 23,378 managers and senior managers in the NHS, but that figure had almost doubled by 2009, having increased to 42,509.
Dr Poulter
The hon. Gentleman might wish to listen to this, but I will take his intervention.
Owen Smith
The hon. Gentleman has returned to this point about bureaucracy many times during our proceedings in the Public Bill Committee. Does he not share my concern about our shared ignorance as to how many managers and how much bureaucracy there will be under the new structure in the GP consortia and in the regional presence of the national commissioning board? Does he know what bureaucracy there will be under this Bill, because I do not?
Dr Poulter
What we do know—the hon. Gentleman would do well to listen to this—is that the NHS currently spends £4.5 billion on bureaucracy, and that could be better spent on patient care. Under the previous Labour Government PCT management costs doubled by more than £1 billion to £2.5 billion, and that money could be better spent on patient care. By scrapping PCTs, we will have more money to give to GPs to spend on patients and front-line care, and that can only be a good thing.
Labour Members would do well to listen to a few more of the statistics on NHS bureaucracy that I am about to read to them. Under Labour, the number of managers increased faster than the number of nurses in the NHS. How can that possibly be right? Managers were paid better than nurses in the NHS. In 2008-09, top managers in NHS trusts received a 7% pay rise whereas front-line nurses received a rise of less than 3%. The Labour party was obsessed with bureaucracy, management and top-down targets, and we would much rather see that money spent on patients and front-line patient care.
Grahame M. Morris
We have heard about the layers of bureaucracy that the coalition Government propose to take away, but what does the hon. Gentleman have to say about the additional layers that they are imposing through the exponential growth of Monitor, which will be the economic regulator? They are increasing its budget from £21 million a year to as much as £140 million a year. How many more thousands of people will it employ? How many lawyers? It will cost £600 million over the course of a Parliament.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We must have shorter interventions.
Dr Poulter
This is very much the point. Let us not forget that Monitor was introduced by the Labour party to regulate competition in foundations trusts, and the Government are looking at giving it a slightly increased role while also cutting £5 billion-worth of bureaucracy in the NHS, which has to be a good thing. I hope that the hon. Gentleman agrees that that £5 billion would be much better spent on patients rather than on management and paper trails.
The core of the issue is that Government Members would like GPs to be placed at the heart of the commissioning process. Giving power to doctors and health care professionals is undoubtedly a good thing because the best advocates for patients are undoubtedly doctors and other health care professionals rather than faceless NHS bureaucrats. I am delighted that my hon. Friend the Member for Ipswich (Ben Gummer) is sitting next to me because far too often in Suffolk damaging decisions to remove vital cardiac and cancer care services from Ipswich hospital have been taken by the strategic health authority and the primary care trust, against the advice of front-line professionals. Community hospitals in my constituency in Hartismere have been closed despite GP advice that we need to look after older people and the growing older population. Putting GPs and health care professionals in charge of the new system will bring better joined-up thinking between primary and secondary care, which does not happen at the moment because GPs are often hindered in what they are trying to do and are unable to communicate effectively with the hospital doctors and trusts they need to talk to because of PCTs intervening in the process. Bureaucrats are getting in the way of good medical decisions and the Bill will deal with that problem.
I am aware that others want to speak in this debate so I shall not speak for much longer. I think that all Government Members must oppose the motion. The hypocrisy of the Labour party in its dealings with health care and the NHS has been ably exposed by my right hon. Friends the Member for Charnwood (Mr Dorrell) and the Secretary of State. Government Members want to cut bureaucracy and put money into front-line patient care and helping patients. We believe that GPs and health care professionals are the best people to do that. We want a patient-centred NHS that is locally responsive to local health care needs and that will properly address the fact that we have an ageing population. We want joined-up thinking between adult social care and the NHS, which did not happen under the previous Government. For all those reasons, I commend the health care reforms to the House, and I beg the Conservative party to oppose the motion.
Paul Blomfield (Sheffield Central) (Lab)
Over Christmas, I found myself using the services of the Royal Hallamshire hospital in Sheffield for emergency eye surgery. I want to take this opportunity to pay tribute to the staff there, who saved the sight in my left eye, which is, as hon. Members might imagine, important to me. That procedure was routine for those staff—something that they did day in, day out. The whole experience—the quick diagnosis, emergency admission, successful operation and supportive aftercare—brought home to me the importance of having a national health service that is not only free at the point of delivery but available equally to all and with the capacity to meet the health care needs of our people. Let me contrast it with the system in the United States, where the quality and speed of treatment depends on patients’ ability to pay. Incidentally, the American system costs the public purse more. I know that some Conservative parliamentarians look at that system with enthusiasm. Many of us will recall Daniel Hannan campaigning against President Obama’s health reforms and describing the NHS as a 60-year old mistake, so it is not surprising that the majority of people in this country do not trust this Government with the NHS. When Government Members talk about monopolies, the people of this country see a public service.
Christopher Pincher
The hon. Gentleman talks about Government Members, but he might note that, other than those on the Front Bench, there are only 11 Members on the Opposition Benches for their Opposition day debate. On the Government side there are more than double that number. Does that not bear eloquent testimony to who really cares about the NHS?
Paul Blomfield
What bears eloquent testimony to who really cares about the NHS is our record. Before 1997, I remember patients being stacked up in hospital corridors in Sheffield every winter because the hospitals could not find beds. That situation has been transformed under Labour over the past 13 years.
The Prime Minister has tried hard to reassure the public that the NHS is safe in Tory hands, but he has failed. In January, a major survey of the British public demonstrated that only 27% of people back moves to allow profit-making companies to increase their role in the NHS. That reflects the way in which our people treasure the NHS and its values, and that is why the Government did not have the confidence to say at the general election what their real intention was: the deconstruction and privatisation of the NHS by stealth.
It is not only the public whom the Prime Minister has failed to convince. The Secretary of State told us again today, as the Government have done many times during discourse on the issue, that we should trust doctors—those who understand the NHS.
Paul Blomfield
I am afraid that I will not; I said that I would give way once and then make progress.
I hope that the Government will take their own advice and listen to doctors, because yesterday the doctors spoke clearly and powerfully with one voice, despite reports that we have seen that under the proposals, doctors could earn up to £300,000. At the first emergency conference of the British Medical Association in 19 years, they sent a clear message to the Government: “Think again.”
Five of Sheffield’s hospitals are in my constituency, and I want to focus on the consequences of ending the cap on private income earned by hospital trusts without providing any safeguards. As hospitals face squeezed budgets, they will inevitably look at every opportunity to enhance their income. At one level, they might see the chance of offering additional services such as en suite facilities to those who can afford to pay, but at another, more damaging level, we need to recognise that in Sheffield and across the country, patients are now being refused non-urgent elective surgery. There are increases in waiting times for knee and hip replacements, and for cataract, hernia and similar operations. Those are not operations for life-threatening problems, but they are hugely important for people’s quality of life. Access to that sort of surgery at the earliest point of need transformed the lives of tens of thousands of people under Labour. Those operations may not be life-critical, but delaying them condemns people to pain and immobility.
Paul Blomfield
No. I have said it once: I have given way, and will not give way again, because I want to make progress.
The Government’s plans mean that as we return to the days of long waiting lists, in will step the health insurance companies, perhaps with their links to new commissioning bodies, which will pitch to those who understandably want the assurance of prompt treatment when they need it. There would be a self-reinforcing cycle: more patients would go private to escape worsening NHS services, and NHS providers would then prioritise private patients, worsening services further. Before long, the NHS would be changed beyond recognition. Its founding principles of free and equal treatment for all who need it would be fundamentally undone. No wonder that the chair of the Royal College of General Practitioners has attacked the plans as
“the end of the NHS as we currently know it”,
or that the Royal College of Midwives has said that
“this could accelerate the development of a two-tier service within foundation trusts, with resources directed towards developing private patient care service at the expense of NHS patients.”
Paul Blomfield
No, I will not. The Royal College of Nursing says that it
“cannot support the removal of the private income cap...Until foundation trusts can credibly demonstrate that private income is not at the expense of NHS patients”.
The proposals reveal the ideological heart of the Government and their vision for public services: a two-tier health system, with the best available for those who can afford it, and the NHS becoming a safety net for those who cannot. I was pleased that last Saturday, in the heart of my constituency, the Liberal Democrats found their voice and spoke out against the anti-state, anti-public-services faction that now leads their party. I say to Liberal Democrat Members, as the hon. Member for Southport (John Pugh) said, “This is our Bill”. This is our motion—support it today.
Mark Simmonds (Boston and Skegness) (Con)
It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield), who I thought was going to give a thoughtful speech. The only comment on which I agreed with him was his congratulations to the hard-working, committed staff in the NHS. I am sure that all hon. Members would agree with that.
I have been disappointed by the debate, but perhaps not surprised. Labour Members’ opposition to the reforms proposed in the Health and Social Care Bill and the evidence presented in support of their motion are based on inaccuracies, incorrect assertions and assumptions, and myths about the destruction and privatisation of the national health service. The plans were clearly laid out in the Conservative and Liberal Democrat manifestos. Two thirds of the country is already covered by GP consortia, many of which are keen to crack on with the reforms so that they can improve the care that they are delivering for their patients.
All Government Members are totally committed to the ethos of the national health service. We are totally committed to a free, taxpayer-funded national health service. Most importantly of all, we are totally committed to continual improvement of patient care. The Health and Social Care Bill will achieve all those things, for the reasons set out by my hon. Friends—ageing populations, increasing costs of drugs and technology, and the increasing level of co-morbidities.
In all the debates about the future of the national health service, no Member of the House should forget the most important factor—the user of the service. Some people on the Opposition Benches seem to have forgotten the patient. The Bill moves patient care in exactly the right direction. The reforms are about high-quality care and value for money for the taxpayers. They transfer resources to front-line patient care by reducing bureaucracy and administration. They are about driving up the quality of patient care and improving patient experience and outcomes.
I have no wish to repeat the Second Reading debate on the Bill, but it is wrong to suggest that everything in the national health service is perfect, and that improvements cannot be made through reform. Putting clinicians in a position to lead commissioning and allowing patients to be involved in the decision-making process will drive improvements. Providing easily accessible patient-centric information to inform choice and raise quality standards will drive improvements in patient care.
Nicky Morgan (Loughborough) (Con)
My hon. Friend is making a powerful argument. Does he agree that it is rather tragic—nay, even worse—that we have heard Opposition Members having a go at the motives of both GPs and those who work in hospitals? Opposition Members think that they are driven by money, not by the quality of patient care and outcomes.
Mark Simmonds
I thank my hon. Friend for the point that she has forcefully made. A few—not all—on the Opposition Benches believe that GPs are in it for the money. No GP I have ever met, or with whom I have discussed patient care, is interested in money. They are there to improve the lives of the patients for whom they are responsible.
If we are to engage seriously with improving patient care, we must allow any willing provider to provide services, and allow the provider that is best for optimising patient outcomes in a regulated way to drive up standards. As my hon. Friend the Member for York Outer (Julian Sturdy) said, it is perplexing to hear the arguments that Labour Members have been coming out with today, and ever since Christmas. Is it right that substandard and mediocre services should be allowed to continue purely because they are provided by the state, even when the patient can get better care elsewhere at the same cost? That has to be wrong. What is important is the quality of patient care that is free at the point of delivery, not the delivery mechanism.
The shadow Secretary of State’s position is completely untenable. He must be squirming inside, because he is an intelligent man and a reformer. The Labour party introduced foundation trusts, payment by results, patient choice and private sector provision in the delivery of patient care, and it twice introduced GP commissioning. As recently as 2010, the Labour party manifesto stated:
“We will support an active role for the independent sector”—
that is in the Bill;
“Patients requiring elective care will have the right, in law, to choose from any provider”—
that is in the Bill;
“All hospitals will become Foundation Trusts”—
that is in the Bill;
“Foundation Trusts will be given the freedom to expand their…private services—.
that is in the Bill. Labour also claimed that it would
“ensure that family doctors have more power over their budgets.”
That is in the Bill. The Labour party should support the Bill, not castigate it on the basis of false promises.
The Government are absolutely right to push the Bill, which is on exactly the right lines. We need more investment in the NHS, less waste and more powers for doctors and nurses to be involved in commissioning and clinical decisions. We need to focus on results, create accountability and transparency, and facilitate innovation. The Bill preserves the best of the NHS—equality of access—and creates the architecture to drive and deliver excellence for all.
Angela Smith (Penistone and Stocksbridge) (Lab)
Thank you, Mr Speaker, for giving me the opportunity to take part in this important debate. Health is undoubtedly one of the most important areas of public policy, and one that the British people care about deeply. We on the Opposition Benches are very proud of our record on the NHS. It was Labour who created the NHS in 1947, and Labour who saved it from Tory destruction in 1997. Under the Labour Government there was significant real growth in the resources going into health care. NHS expenditure increased by more than two thirds over 13 years, with real-terms growth averaging around 5.5% per annum. Those high rates of investment led to improvements in hospital waiting times, life expectancy and health outcomes.
It is all too easy to forget what the NHS was like under the previous Tory Government. People waited for years for treatment such as hip replacements, and it was common for patients to spend hours in the cold corridors of old hospitals built in the 19th century while waiting for beds to become available. We changed that by building new hospitals and employing more doctors and nurses.
Angela Smith
I will give way once and no more, because I want other Members to have an opportunity to speak.
Henry Smith
I am interested to hear the tale of life in the NHS before the Labour Government and now, because under Labour my constituents lost hospital provision, including accident and emergency and maternity services. That was the Labour experience in Crawley.
Angela Smith
All I will say to the hon. Gentleman is that I worked in the NHS as one of the so-called bureaucrats in the Tory ’80s, and I remember having a patient crying to me over the phone, begging me to admit him so that he could have his eye taken out, because the Tory NHS was not providing the beds or the theatre space for such operations. We changed that by investing in the NHS so that life chances for many people could be improved. There is no doubt that there are people alive today who would not be so had that investment not been made.
Before the election, the Tories promised to protect the NHS with real-terms increases in spending. Let us get one thing straight: the 0.1% per annum increase that the coalition Government said they would provide does not equate to real increases in spending, because since then inflation rates have gone through the roof. There is no real-terms increase in spending, so one has to ask why the Government want to divert a further £2 billion from tight budgets into a top-down, ideologically driven reorganisation, especially when the coalition agreement specifically stated that the Government would not do that.
Furthermore, it is a reorganisation that no one wants—and that includes the Lib Dems, as we saw with last week’s vote in the great city of Sheffield. Just this week the BMA voted against the proposals, and many other health professionals think that they are dangerous and ill thought through. Without the support of anybody, it seems, the Government are intent on forcing through
“the biggest…upheaval in the health service, probably since its inception.”
Those are not my words but the words of Chris Ham, the chief executive of the King’s Fund.
I have a fundamental disagreement with the Secretary of State’s view that competition and free markets will drive innovation in the NHS, and that profit will motivate performance. I do agree, however, with my hon. Friend the Member for Kingston Upon Hull (East) (Karl Turner), when he says that the introduction of these reforms risks removing the N from NHS. No longer will we have a national service; instead, the system will be fragmented and the postcode lottery of service will become more and more prevalent.
The notion of “any willing provider” means that many NHS hospitals will be at a disadvantage compared with private providers, which will not have to provide a comprehensive service for complex problems. “Fine,” some might say, “if that brings costs down”—but what happens when hospitals and other treatment centres become insolvent and have to close down, leaving many areas of the country without adequate health care provision? Handing over £80 billion to GPs to commission services not only risks the important relationship between patient and doctor; it is extremely risky in itself, because of the lack of accountability.
If the plans are passed unaltered, GPs, through the quality premium bonus, will have a financial incentive to keep costs down and not to refer patients for diagnostic tests or treatment. As we found the last time the Tories tried to undertake such a scheme, they could also become unwilling to take on costly patients with chronic conditions. Those who need the most help could find it more and more difficult to get the treatment that they require.
Of deeper concern is the opaque nature of the consortiums. They will have to produce annual financial reports only for the national commissioning board, and they will not have to publish them. At the same time, every council in the country will have to publish every invoice over £500.
These health reforms have no mandate with the British people. They were in neither of the coalition parties’ manifestos, and even if NHS funding were not being cut, they would still run the clear risk of destabilising the service, because they hand over £80 billion of taxpayers’ money to private institutions, with insufficient safeguards in terms of accountability. The reforms are simply wrong. To allow any willing provider to deliver services risks the destruction of the NHS and a return to the dark days of the 1930s, when we had a two-tier system, with the state providing a minimum service and those who could afford to going private. That, too, would be plainly wrong, and something that the British people have consistently said they would not want.
It was pleasing to see the Lib Dem grass-roots vote against the policy last week, so I say to Lib Dem Members, “The ball is in your court. You can be on the right side of this argument, and your party can be on the right side of the British people, if you go through the Lobby tonight with us. The choice is yours. Flex your muscles and demonstrate that you are prepared to force the Government to revisit their plans by voting with Members on this side of the Chamber tonight.”
Andrew George (St Ives) (LD)
It is a pleasure to follow the hon. Member for Penistone and Stocksbridge (Angela Smith), who made a number of important points about the extent of the reorganisation, quoting Chris Ham of the King’s Fund. Indeed, a number of other authoritative sources point out that these reforms amount to the most significant reorganisation of the NHS since its inception 62 years ago. Therefore, we need to look with great care at the issues that arise as a result of this substantial change. We are talking about the public institution that the majority of people in this country hold most dear, so we have a great responsibility in this House to deal with these issues seriously.
I query the hon. Lady’s final point on the purpose of today’s debate. If the intention was to alienate those who broadly share her and the shadow Secretary of State’s analysis of the Bill, then adopting the device of today’s debate was probably the best way of doing so, so I congratulate them on that. Following the debate in our conference in Saturday, I would say that if Labour Members have a significant interest in the future of the NHS, the most appropriate thing to do would be to try to form a coalition of the people who share concerns about the Bill. Many of the institutions that she and others quoted—the King’s Fund, the BMA, the GMC, the royal colleges and many others—share concerns on the basis of a very objective and dispassionate point of view and could make a significant contribution. That is how we should be doing it, not by using—I am sorry to describe it thus—the playground politics of an Opposition day debate as a means of advancing the issue.
Angela Smith
Is the hon. Gentleman indicating that he would be prepared to talk to Labour Front Benchers on meaningful ways of taking this debate forward?
Andrew George
I am prepared to talk to anyone who wants to engage constructively in improving the Bill to ensure that it achieves its stated intentions, because I do not think that it will, given the nature of the reorganisation proposed in it. The reason I will not be joining the hon. Lady and her colleagues in the Lobby to support the motion is that it is tactically wrong at this stage to engage in such antics. This issue is a great deal too important to be turned into a party political playground game.
I am pleased that the Secretary of State said today that he is prepared to listen and engage. We need to explore every opportunity to engage in constructive dialogue with him, involving all the stakeholders I mentioned, and, indeed, those in the Labour party who want so to engage, to find a way through and to ensure that the genuine concerns about the impact of the Bill are properly scrutinised. Yes, they are being scrutinised in the Bill Committee, but before we get to Report stage in this House, it is important that we create a coalition of the bodies that share these concerns. Rather than inviting them to go out on to Parliament square and wave their placards and so on, it would make a lot of sense to encourage them to engage in greater constructive dialogue than we have succeeded in achieving so far.
Mr Dorrell
Does my hon. Friend agree that the case he is making is reinforced by the fact that our right hon. Friend the Secretary of State has already moved two amendments to the Bill dealing with the cherry-picking issue and—this was mentioned by the Prime Minister today—price competition. The amendments have been tabled to ensure that the Bill addresses concerns expressed by the hon. Gentleman and some of his hon. Friends.
Andrew George
I am grateful to my right hon. Friend. Indeed, that is a very encouraging indication of the fact that the Secretary of State is prepared to listen. As far as I am concerned, however, he is not prepared to go far enough in reassuring me on those points, because taking the word “maximum” out of the clauses relating to price competition and the role of Monitor, the market regulator, is still insufficient. We have not got time to debate that today.
There are several issues, through which I shall canter in the few moments I have left, about the Bill’s objectives and what we want to achieve. First, we want to drive patient choice and innovation. I do not think that anyone would disagree with that, but we do not need to demolish the core—or at least the institutional architecture—of the NHS and PCTs, and alienate the majority of clinicians against achieving such innovation and patient choice.
Again, I think we all agree that giving power to communities and patients is highly desirable. However, although GPs will be given responsibility for commissioning services through the consortia, I do not think that they are particularly asking for that. Having spoken to many of them and listened to the national debate, I believe that they are reluctant, or at best resigned to taking on those roles, feeling that they have to follow that course.
If we want decentralisation, why will we end up with the ludicrous centralisation of commissioning NHS dentistry and dispensing? Indeed, every contract for a GP surgery will be centrally commissioned from an NHS commissioning board in Leeds. That is absurd. It does not even achieve what it is claimed that the Bill wants—decentralisation.
Many attempts have been made to argue that the Bill will cut bureaucracy and managers. I am not sure that that will happen. A big focus of today’s debate is the impact of competition, which will be unleashed. Once the private sector has its foot in the door, the genie will be out of the bottle. It is clear that everything, including designated services, in my view, will be open to contest. Although it is claimed that the Bill will result in fewer managers, I think that it is a dream come true for litigators, lawyers and management consultants.
Andrew George
I am afraid that I do not have time.
The idea that the Bill will drive integration and social care is more wishful thinking because there will be less coterminosity between commissioning boards and local authorities under the Government’s proposals for an increased number of commissioning bodies than we have now.
Much rethinking needs to be done, and I hope that Government Front Benchers are listening.
Helen Jones (Warrington North) (Lab)
In the devastation that followed the second world war, this country had the courage and the vision to realise the dream of a health service available to all in times of need. If the Government’s plans go ahead, that dream will die. [Interruption.] Yes, it will. It is not simply that the reorganisation represents a broken promise, which it does, or that it is costly, although it is, but that it strikes at the very foundations of the NHS. Indeed, if it goes ahead, there will no longer be a national health service, but a vast postcode lottery, with treatment depending on where people live.
Helen Jones
I am sorry—I have not got time. [Interruption.] Other Members are waiting to speak and I will not give way.
The market, not the patient will be king. That is being done under the cloak of localism—the Government’s current buzz word. Remove the cloak and we will see the realities: an NHS driven by the market, run by a vast, unelected and unaccountable bureaucracy, with accountability to Parliament greatly reduced.
The Government plan to give all commissioning to GPs. They conveniently ignore the fact that if GPs wanted to be managers, they would have taken MBAs rather than medical degrees. They will bring in other companies—mostly private—to do the managing.
Helen Jones
I have said no. The hon. Lady was not even here for the beginning of the debate.
It is not sufficient for the Government to ensure that private companies determine our health care; they will also introduce EU competition law into the NHS. That means that the private health companies that are currently hovering over the NHS like a bunch of vultures will threaten legal action if services are not put out to tender. They will then cherry-pick the services in which they can make the most money—they do not want to do geriatric care, paediatrics or A and E. That will fatally wound and undermine local hospitals and some, no doubt, will go to the wall. It is no surprise that the Health and Social Care Bill includes detailed insolvency provisions.
Some hospitals will bring in more private patients to fill the gap, because the Bill lifts the cap on private patients. We will therefore have the absurd situation of private companies making decisions on health care, and of NHS staff and facilities being used not for those most in need, but for those with the ability to pay. There is a word for that and it is not often used in this House: it is quite simply immoral. It is also indefensible.
At the same time, these plans will undermine our ability to deal with long-term conditions. Progress has been made on conditions such as stroke through co-operation, not competition. It has been made through stroke networks, by sharing expertise and by reconfiguring services to get the best deal. All the expertise in primary care trusts on delivering those services will be swept away.
Helen Jones
I have made my view clear, so the hon. Gentleman is wasting his time. The expertise will be swept away, and the plethora of GP commissioning consortia will have no strategic overview of these services.
There has always been a democratic deficit in the NHS, but the Bill will increase it vastly. It will give £75 billion to £80 billion to unaccountable consortia. It will remove from the Secretary of State the requirement to secure the provision of services. I say to Government Members: when the services go, do not come here to complain because the Secretary of State will not be responsible any more. The NHS commissioning board will be appointed by the Secretary of State and he will be able to dismiss its members at will. It will have no independence. Monitor will not have a single elected member.
The Bill does not give power to patients, and it does not empower health service staff. Kingsley Manning of Tribal summed it up cleverly as a Bill to denationalise the NHS. It is not supported by doctors, and it is not supported by patients. I say to the Liberal Democrats that if they go through the Lobby tonight in support of this reorganisation, people out there will not forget and they will not forgive.
Liz Kendall (Leicester West) (Lab)
This debate is about one of the most important issues facing this House and this country: the future of our NHS. It has been an excellent and at times lively discussion, with important contributions from all parts of the House.
My hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke with great passion about his recent experience of using the NHS and the importance of the NHS for his constituents. My hon. Friends the Members for West Lancashire (Rosie Cooper), for Oldham East and Saddleworth (Debbie Abrahams) and for Kingston upon Hull East (Karl Turner) gave compelling speeches about their concerns over what is really in the Health and Social Care Bill, including the implications of removing certain duties from the Secretary of State and of introducing competition law explicitly in the NHS for the first time. The hon. Members for Southport (John Pugh) and for St Ives (Andrew George) raised important and serious issues with regard to the Bill, including the implications of centralising services such as dentistry, pharmacy and primary care. It is far from clear how a national body will know what primary care services need to be commissioned in my constituency. They also expressed concerns about the dangers in the Bill. My hon. Friend the Member for Warrington North (Helen Jones), whom I am proud to be following, raised the importance of the threats to the “national” in the national health service and concerns about patients with long-term and chronic conditions, of whom we know there are an increasing number in the NHS.
The debate has shown that, as on so many occasions with this Government, it is not their rhetoric but the reality that counts. They promised in their manifesto an end to top-down reorganisations, but instead they are forcing the NHS through the biggest reorganisation of its life. As the right hon. Member for Charnwood (Mr Dorrell) has said many times, although unfortunately not in the House today, they are doing that at a time when the NHS faces its toughest ever period of funding, when jobs are already being cut and when, far from what the Secretary of State told the House earlier, waiting times are starting to rise.
The Government also say that they want clinicians to lead changes in the NHS, but their Health and Social Care Bill fails to guarantee even that GPs will be running consortia, let alone that hospital doctors, nurses or other NHS staff, who are so crucial to improving the quality of care, will be involved. As eight of the country’s leading patient charities said in a letter to The Times last month:
“The reforms will place £80 billion of the NHS budget into the hands of GPs, but plans to make GP consortia accountable to the public are far too weak.”
There is no requirement to have elected representatives on GP consortia, as the coalition agreement promised for primary care trusts. The new health and well-being boards will have no power to require GP consortia to do anything, and local councils’ scrutiny committees will actually lose some of their powers to refer decisions to the independent reconfiguration panel in the case of services not on the safe list of designated services.
At the heart of the Bill are proposals to change the NHS fundamentally that the Secretary of State simply does not want to talk about: his plans to run the NHS along the same lines as the gas and electricity companies.
Nicky Morgan
I know that the hon. Lady is a hard-working fellow Leicestershire MP, but I disagree with her. Is not the fundamental principle of the Bill, as we have discussed in the Public Bill Committee, that what constituents want is an NHS free at the point of need and the delivery of services, and funded by taxpayers? Which part of the Bill changes that fundamental principle?
Liz Kendall
What patients want is their views and voices to be heard. As the hon. Lady well knows, eight of the country’s leading patient charities, including the Alzheimer’s Society, Asthma UK and Diabetes UK, have said that the patient and public voice is not strong enough under the Bill, and they have demanded changes. I respectfully ask that she look at their comments and act on their views.
The fundamental issues at the heart of the Bill are turning Monitor, which is currently responsible for foundation trusts, into a powerful new economic regulator to promote competition across the NHS, and enshrining UK and EU competition law into primary legislation on the NHS for the first time. That is not my view but the view of David Bennett, the new chairman of Monitor, expressed in his evidence to the Public Bill Committee. The Government are explicitly modelling the NHS on the gas, electricity, railway and telecoms industries. Government Members who are shaking their heads or looking blank should read the explanatory notes to the Bill, which make that absolutely clear.
Grahame M. Morris
May I point out that yesterday, in an Adjournment debate in Westminster Hall about the future of the blood services contract, the Under-Secretary of State said in response to a question from my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) that EU competition rules would apply?
Liz Kendall
The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), also said yesterday, in the Health and Social Care Bill Committee, that EU competition law would apply, and gave me some assurances that that would somehow not change anything. When I asked whether the Government had taken legal advice on that, he admitted that they had. I asked him then to publish that advice so that hon. Members did not have to take my word for it, and I shall do so again. Will he publish that advice so that hon. Members can see whether GP-commissioning consortia and providers will be subject to EU competition law? Sadly, it appears that he will not do so.
Dr Poulter
If the hon. Lady is so concerned about competition and markets, why did the previous Government introduce Monitor, and why were they happy to pay the private sector 11% more than the NHS to provide NHS services?
Liz Kendall
I am sure the hon. Gentleman knows that Monitor was established as part of the regulation of foundation trusts. Removing that responsibility will mean that there will be no outside checks and balances on those trusts as there are now. Government Members should think seriously about that.
Our health and our NHS are not the same as gas, electricity or the railway. That the Secretary of State believes that they are shows how dangerously out of touch he is. What is the likely result? GPs will be forced to put local services out to tender even if they are delivering good quality care that patients choose and like; hospitals and community services will be pitted against one another when they should work together in patients’ interests; care, which as many hon. Members have said is vital as our population ages and there is an increase in long-term conditions, will become more and not less fragmented; the financial stability of local hospitals will be put at risk, and they will have no ability to manage the consequences of choice and competition in the system; and the whole system will be tied up in the costs of red tape, as GPs and hospitals employ an army of lawyers and accountants to sign contracts and fight the threat of legal challenge, huge fines and the potential of being sued. Let us also be clear that the Bill gives Monitor the same functions as the Office of Fair Trading, so it can fine organisations up to 10% of their turnover.
The more we see of the Bill, the more the truth becomes clear. The Secretary of State says that he wants clinicians to be more involved, and “no decision about me without me” for patients, but when the Royal College of General Practitioners, the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Midwives, the British Medical Association or anyone else tells him that he should stop, think again and halt his reckless NHS plans, he refuses to listen. When the Alzheimer’s Society, the Stroke Association and Rethink tell him that his proposals will not give patients a stronger voice and improve public accountability, he simply tells them that they are wrong. When health experts such as the King’s Fund warn that driving competition in every part of the NHS will make it more difficult to commission the services that best serve patients’ interests, he simply puts his fingers in his ears and walks away. What makes this Secretary of State think that he is right when professional bodies and patient groups know that he is wrong?
Doctors and nurses do not support the Government’s plan, patients do not want it, some Conservative Back Benchers and members of the Cabinet do not like it, and the Liberal Democrats hate it. They had the sense last Saturday to see what the hon. Member for St Ives (Andrew George) called the potential catastrophe as far as the future of the NHS is concerned, and to ask for amendments to the Bill. I hope they have the sense to join us in the Lobby tonight. I commend the motion to the House.
The Minister of State, Department of Health (Paul Burstow)
I start by thanking the right hon. Member for Wentworth and Dearne (John Healey) for attending the Liberal Democrat conference last Saturday. Unfortunately, no one knew who he was when he arrived. Had he been more clearly identified, I am sure he would have received a very warm welcome from delegates, because he was welcome, as was the registration fee he paid. He will know that I gave my Liberal Democrat colleagues a guarantee on Saturday that, along with other members of this Government, we will listen to every word that Liberal Democrats said at that event.
I agreed with my hon. Friend the Member for Southport (John Pugh) when he said that it was important that we should drop the rhetoric and listen. However, I am not absolutely certain—if I can say this gently to him—whether his contribution entirely measured up to his own statement. Dialogue, yes, but dialogue is not diatribe. Let me also tell him that had the amendment in the name of Conservative and Liberal Democrat Members been selected, I would have urged hon. Members to vote for it, because it sums up the Government’s approach. We are listening to concerns and seeking to strengthen and improve the Bill, and we will continue to do so.
However, that is not what Labour is about. Labour’s purpose is very clear indeed. Those on the Labour Front Bench let the cat out of the bag a few weeks ago when the hon. Member for Islington South and Finsbury (Emily Thornberry) said in Committee that
“many of our amendments seek to undermine the Bill entirely and in every way possible”.––[Official Report, Health and Social Care Public Bill Committee, 3 March 2011; c. 448.]
That is not about improving the Bill; that is about trashing it. Sometimes it seems like we are debating two entirely different Health and Social Care Bills. One is the Bill currently in Committee—the real Bill. The other is the phantom Bill that has been conjured up by Labour Members—a hall of mirrors constructed by the Labour party and the unions that bears no resemblance to the real Bill, and is a gross distortion of so many of its provisions. Let me deal with some of the myths that have been peddled in today’s debate.
First, let me address the charge of privatisation. I thought that the
“ideological battle over using private and third sector providers”
was “over,” and that
“What matters to the public is not who provides but how well a service is provided.”
That is not just my view; that is the view of the Labour Business Secretary from 2008, the former Member for Barrow and Furness. He was a long-standing Health Minister who took that view then and, I suspect, holds it today. My right hon. Friend the Member for Charnwood (Mr Dorrell) was absolutely right: the involvement of the private sector is not new to the NHS. Indeed, involving the private sector was certainly not new to the last Government. Labour imposed private sector treatment centres on the NHS, guaranteed the private sector higher prices and, through all that, institutionalised cherry-picking in the NHS. Indeed, it is a scandal that in none of the Opposition speeches was there any sense of an apology for the £250 million spent on the private sector for doing absolutely nothing.
Instead of loading the dice in favour of the private sector, which is what Labour did, we are correcting the balance, creating a fair playing field for the full range of providers—something that Labour said in its manifesto it would do, but which it is running away from in opposition. We have tabled amendments to the Health and Social Care Bill to put beyond doubt the fact that there will not be price competition, but there will be quality competition, to ensure that, unlike Labour, we will not see differential prices set on the grounds of ownership. Under our plans there will be less competition on price than there is now and more competition on quality.
Angela Smith
Shirley Williams described the level playing field to which the hon. Gentleman refers as “lousy”. How would he respond to that?
Paul Burstow
I am looking forward to further dialogue with my noble Friend to ensure that we deliver the important improvements to the NHS that will ensure that unlike Labour, which cherry-picked and set up contracts with the private sector that undermined the NHS, we deliver a level playing field that delivers good quality care, chosen by patients not politicians.
The debate has shown that we continue to share an enduring commitment across the House to the notion that the NHS must be based on need and free at the point of use. That is what the Bill entrenches and what it will secure. Our plans are all about offering more choice to patients, more accountability for the public and more autonomy for front-line professionals. It is easy for the Opposition to attempt to caricature and distort those policies, but they are based on our belief that we need an NHS that is not about looking up to Whitehall for its lead, but about looking out to its communities and ensuring that it delivers the quality services that make a difference to our constituents.
The purpose of the motion is very clear. It is nothing to do with listening; it is all about scaremongering, opportunism and grandstanding, and the House should throw it out. We will continue to listen and to improve the Bill, but we will not do it by listening to Labour Members, who have no interest in making the NHS better and who would have cut it, had they had the opportunity to do so in government.
Question put.
Owen Smith (Pontypridd) (Lab)
On a point of order, Mr Deputy Speaker. You were not in the Chair at the conclusion of the Opposition day debate, but the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), used barely half his allotted time in winding up, as he was clearly short of arguments to defend his position on the important subject under discussion. That left many of us who have plenty to say on the subject short of time to speak. Will you work through the usual channels, Mr Deputy Speaker, to make sure that in future either Ministers use all their time or Back Benchers are given more time to speak?
Mr Deputy Speaker (Mr Nigel Evans)
How long the Minister wishes to speak for is not a matter for the Chair. The Minister spoke, the debate came to an end, and a vote was taken.