(6 years, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
18:59 - The House divided: - Ayes: 230 / Noes: 295 - Question accordingly negatived.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I beg to move,
That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care Committee: written submissions received by Ministers since 8 June 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister’s Office.
In six weeks’ time, we will celebrate the 70th anniversary of the national health service, a great civilising moment for the nation, which the Secretary of State’s predecessor, Nye Bevan, described in the House on Second Reading of the National Health Service Bill. He said of the creation of the NHS that
“it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]
They are certainly stirring and inspirational words, but as we approach the celebrations and the 70th anniversary of the NHS, we see a service in crisis, underfunded and understaffed, and patient care is suffering.
After eight years of the biggest financial squeeze in its history, and at a time when England’s population has increased by 4 million, when the falling real value of tariff payments for hospital care means that trusts now lose 5% of costs for every treatment, and when the Government have refused time and again to give the NHS the funding required, we see patients suffering every day in our constituencies. That is why we have just suffered the worst winter in the history of the NHS, when our hospitals were overcrowded and our A&E departments were logjammed. The number of hospitals operating at the highest emergency alert level—the OPEL 4 level—was nearly double what it was the year before, which itself was branded a humanitarian crisis.
In the first week of January 2018, there was a point when 133 out of 137 hospital trusts in England had an unsafe number of patients on their wards. Sixty-eight senior accident and emergency doctors wrote in January to the Prime Minister raising
“the very serious concerns we have for the safety of our patients.”
In response, we had a blanket cancellation of elective operations and cancellations of more than 1,000 emergency operations, causing misery for patients and financial difficulties for trusts already in deficit.
Gareth Thomas (Harrow West) (Lab/Co-op)
My hon. Friend should also be aware that many walk-in centres have closed. In my constituency, the superb Alexandra Avenue centre has had a 20,000 cap imposed on the number of patients it can see. This service is run by popular GPs, but it faces the risk of being outsourced, to a Virgin healthcare or someone else. It originally served 40,000 patients, and many of my constituents are genuinely worried for its future.
Jonathan Ashworth
My hon. Friend makes the point well. I believe about 50 walk-in centres have closed and there are another 50 whose future has been reviewed.
Karen Lee (Lincoln) (Lab)
Lincoln’s walk-in centre was closed. A consultation was undertaken by the clinical commissioning group and 94% of those who responded did not want the centre to close. So what did the CCG do? It closed it.
Jonathan Ashworth
I thank my hon. Friend for her contribution. I know that she, as the relatively new Member for Lincoln, will be campaigning for the future of health provision in her constituency.
The response of the Prime Minister to those cancelled operations this winter was to shrug her shoulders and say, “Nothing is perfect,” but by the end of the winter reporting 185,000 patients, often elderly, vulnerable and in distress, had been left waiting in the back of an ambulance or treated in a corridor for more than 40 minutes. We do not have a crisis in our NHS just in winter; we have a crisis all year round. Since 2010, we have seen a reduction of about 16,000 beds, including more than 5,000 acute beds and nearly 6,000 mental health beds—that is almost 20% of them. Among equivalent wealthy countries, only Canada and Poland have fewer doctors per head, and only two countries have fewer beds per head.
A report today in The Guardian details how old and out of date the equipment is in hospitals because infrastructure budgets have been raided. According to the OECD, we are bottom of the league for the provision of CT and MRI scanners. Meanwhile, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has pointed out, eight years of multi-billion cuts to social care provision have decimated the sector and have denied 400,000 people, often the elderly and the vulnerable, the support they would otherwise get.
Years of pay freeze, and failure to invest in and plan properly for the workforce, have meant vacancies for 100,000 staff, including vacancies for 40,000 nurses, 3,500 midwives and 11,000 doctors. In the past two years, we have lost more than 1,000 GPs. In our communities, we have seen district nurses cut by 45%. We have lost more than 2,000 health visitors in two years. We have lost nearly 700 school nurses. There are 5,862 fewer psychiatric nurses and 4,803 fewer community health nurses than in 2010, and the Prime Minister’s hostile environment has meant the Home Office has turned down visas for at least 400 staff.
Conor McGinn (St Helens North) (Lab)
In the St Helens and Knowsley Teaching Hospitals NHS Trust, the spending on agency nurses has quadrupled since 2011. Is it not a fact that under this Tory Government we have a retention, recruitment and resources crisis in our NHS?
Jonathan Ashworth
My hon. Friend has, with great eloquence, explained why failing to plan properly on the workforce is such a false economy. It means that trusts are spending more and more on locums and expensive agencies.
I trust that no Conservative Member will try to pretend in this debate that it is possible to reduce beds, reduce staff, cut social care and fail to invest while patient numbers are increasing without the quality of care suffering. If any Conservative Member does try to tell us the opposite, they should look at the latest performance standards. The lack of hospital capacity and staffing means that the waiting list has risen to more than 4 million. Simon Stevens, of NHS England, has warned that
“on the current funding outlook, the NHS waiting list will grow to five million people by 2021. That’s an extra million people on the waiting list. One in 10 of us waiting for an operation—the highest number ever.”
The blanket cancellation of elective operations has seen waiting lists rise by nearly 5% compared with last year, and we have waiting times up and performance against targets down. In overcrowded A&Es, in the past year, 2.5 million have waited more than four hours. Just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March—that is the lowest proportion since records began in 2010.
Wes Streeting (Ilford North) (Lab)
Of course, A&E waiting times would not be as long if the Government were investing properly in primary care. In my borough, we have the ludicrous situation of private companies advertising in London underground stations, saying:
“Fed up waiting? Our private GPs can see you now…ONLY £80”.
Does my hon. Friend agree that people should not be forced to pay £80 to see a GP, and they should not be waiting unnecessarily long in A&E because of the Government’s failure properly to fund and deliver the workforce that primary care needs?
Jonathan Ashworth
My hon. Friend has hit the nail on the head. The problem is that, when the Government allow our national health service to deteriorate by such a scale and push it into this level of crisis, they are essentially forcing people, often reluctant refugees from a public NHS, into self-pay options. That is what happened last time the Conservatives were in government and it is happening again.
Anna Soubry
Will the hon. Gentleman confirm that five GP surgeries in Broxtowe have been rated outstanding and that we yet again have a 2% increase in CCG spending? Why is he always talking down the NHS?
Jonathan Ashworth
I am delighted that GPs in Broxtowe have been rated outstanding, but patients in Broxtowe will be concerned that bed occupancy rates at Nottingham University Hospitals Trust are at 94.9%. That is what people in Broxtowe and across the east midlands are concerned about.
Anna Soubry
Would the hon. Gentleman like to speak to Nottingham City Council, which is run by Labour? It has repeatedly refused to unblock beds at NUHT, unlike Conservative-run Nottinghamshire County Council, which always ensures that it has social care available so that there is no bed-blocking in Nottinghamshire. The problem is Labour in the city—
Jonathan Ashworth
I know that Councillor Jon Collins of Nottingham City Council is a talented man, but he does not run Nottingham University Hospitals Trust. The people running the health trusts are the chief executives, who have to rely on the budget settlements that the right hon. Lady and her party have been denying—
Jonathan Ashworth
No, I am not giving way again. The right hon. Lady has had two chances; she can contribute to the debate later.
We have overcrowded A&Es and—perhaps the right hon. Lady can listen to this—patients are not even able to get a bed, often lying confused on trollies in corridors. In the last year of the previous Labour Government, 60,000 people were designated as trolley waits—
Anna Soubry
On a point of order, Mr Deputy Speaker. Could the record please record that indeed the leader of Nottingham City Council does not run NUHT, but he is responsible for social care in the city? That was the point I was making.
Jonathan Ashworth
I am grateful to the right hon. Lady for that. I invite her to make another point of order, because Nottinghamshire County Council is closing five care homes.
Anna Soubry
I am happy to take that up. My understanding is that Nottinghamshire County Council is looking responsibly at the provision of—[Interruption.] Well, the hon. Gentleman invites me to give him information; I am trying to assist him. In my constituency, the county council is making sure that the money that it spends on social care goes to the very many care homes in my constituency that are rated as good or outstanding—
Mr Deputy Speaker
Order. May I just help a little? We have 25 speakers to come in after the Front Benchers, so I appeal to the Front Benchers to leave time for Back Benchers to contribute.
Jonathan Ashworth
I shall take your guidance, Mr Deputy Speaker. It is always a pleasure to indulge the right hon. Lady, but I have to point out to her that Councillor Cutts of Nottinghamshire County Council is cutting care homes across Nottinghamshire. The record will show that.
Jonathan Ashworth
Given that Mr Deputy Speaker has just castigated me, let me make a little progress. Hopefully, I will be able to take more interventions towards the end of my remarks.
Underfunding and lack of capacity have driven more and more—
Jonathan Ashworth
Mr Deputy Speaker has asked me to make a bit of progress, so let me do so.
Underfunding and lack of capacity have driven more and more NHS purchasing from the private sector. We have seen beds lost in NHS hospitals, which are then increasingly forced to use the private sector. Spending on elective treatments outsourced to the private sector rose from £241 million in 2015-16 to £381 million in 2016-17. In many instances—from mental health provision and detox services for those suffering from substance misuse, to routine elective operations—we often see a poor quality of service in the private sector. The House does not have to take my word for it; the Secretary of State himself intervened recently to demand that the private sector gets its house in order. These risks have been known for years, since the Paterson scandal, and I note that the Government are not proposing to legislate.
Several hon. Members rose—
Jonathan Ashworth
I will make a bit of progress because Mr Deputy Speaker has asked me to do so.
I say to the Secretary of State that, if he is prepared to legislate, we will support him because we know that, when things go wrong in the private sector—often these hospitals have no intensive care units—it is the NHS that has to step in and act as a safety net, with patients often being transferred from a private hospital to an NHS hospital. That risk has been estimated to cost the NHS £60 million.
Several hon. Members rose—
Jonathan Ashworth
Let me make a bit of progress and then I will try to let others in.
If the Secretary of State brings forward legislation, we will work constructively with him.
The latest and perhaps most pernicious consequence of underfunding is the move to so-called wholly owned subsidiaries. Many are saying that this is a VAT scam. Hospital trusts feel that, because of underfunding, they have no option but to transfer staff to these so-called subsidiaries, set up at arm’s length but still owned by the trust. We have trusts paying management consultants a total of £3 million, according to freedom of information requests, for advice on setting up these new arrangements. That is money that should be going on patient care. It will mean a two-tier workforce as new joiners no longer need to be on “Agenda for Change” terms and conditions. That looks to many like forcing staff to pay for the Government-imposed financial crisis in the NHS.
Mr Philip Dunne (Ludlow) (Con)
I thank the hon. Gentleman for giving way. He is under a lot of pressure, rightly, in this debate. When he selected the motion for the Opposition debate today, was he aware, given the liturgy of supposed privatisation that he has alleged has taken place under this Government, that the proportion of spend on the independent sector under the Conservative Government in the last year was zero and that the proportion of spend on the independent sector in Wales, run by the Labour Administration, went up?
Jonathan Ashworth
I am grateful to the former Minister of State. We do miss him during our exchanges at the Dispatch Box. The figures that he has quoted are different from those provided by the Library. The Library says that the percentage of the total budget spent on private providers has gone up to 1% in Wales, but it has gone up by 2% in England in the past year. The Department of Health and Social Care may have different figures, but those are the figures from the Library.
Yvonne Fovargue (Makerfield) (Lab)
Will my hon. Friend send his support to the staff from Wigan hospitals who are today striking in protest at the creation of Wrightington, Wigan and Leigh Solutions? Does he agree that that is just privatisation by the backdoor?
Jonathan Ashworth
I do agree. May I reassure my hon. Friend that those Unite and Unison members who are taking industrial action at Wrightington, Wigan and Leigh have our support? We stand with them in solidarity. I congratulate her and my hon. Friends the Members for Leigh (Jo Platt) and for Wigan (Lisa Nandy) on the campaign that they have been running. These jobs should not be outsourced to wholly owned subsidiaries; they should be in-house.
Sir Nicholas Soames (Mid Sussex) (Con)
I am very grateful to the hon. Gentleman for giving way. I know him to be a good man. May I put this to him? None of these figures or statistics means anything to people wanting treatment on the NHS. May I assure him that my constituents, like his, are not over-concerned where their treatment comes from? What they are concerned about is that they should be competently, effectively and caringly treated under the national health service.
Jonathan Ashworth
I say to the right hon. Gentleman, of whom I am tremendously fond, as he knows, that I agree broadly with the point that he is making. If my memory serves me correctly, he sits for a Sussex constituency and, of course, in Sussex, we had the shambles of a patient transport contract that went to a firm, Coperforma, which did not even own any ambulances and which was leaving patients stranded on their doorstep waiting for transport to dialysis appointments and to chemotherapy appointments. It often could not then pick up the patients from the hospital and take them home. That contract had to come back in-house. It is these types of privatisation that we believe are doing great damage to the health service.
Jonathan Ashworth
My hon. Friend has been very patient, so I will give way to him.
Mr Cunningham
My hon. Friend has been generous in giving way. Does he agree that private companies are also increasing car parking charges, which is a tax on patients, and that, more importantly, because of the lack of social workers we have bed-blocking in the national health service, too?
Several hon. Members rose—
Jonathan Ashworth
The hon. Member for East Worthing and Shoreham (Tim Loughton) seems so desperately keen that I will take his intervention and then I will hear from Ashfield and make some progress.
Tim Loughton (East Worthing and Shoreham) (Con)
I am really grateful to the shadow Minister. Under the last Labour Government, before Worthing became the outstanding hospital it is now, there was a long list of patients requiring hip and knee replacements. To speed up the list, the hospital contracted with a local private hospital. Those patients were treated much more speedily, at least to the same quality, and actually at a lower cost per patient than if it had been done in-house— and, of course, the patients did not have to pay a penny themselves. Is that the sort of privatisation the hon. Gentleman so opposes?
Jonathan Ashworth
I can reassure the hon. Gentleman that no, it is not. I agree with the Secretary of State that the
“use of the independent sector to bring waiting times down and raise standards is not privatisation.”
They were the words of the Secretary of State when he spoke at his own party conference the other year. The Labour Government did spot-purchase from the private sector to bring down the huge waiting lists that we inherited in 1997; but our concern is about contracts for delivery of healthcare services being handed out to private sector providers who not only provide poor quality to patients but give the taxpayer a poor deal. It is a different situation.
Gloria De Piero (Ashfield) (Lab)
Thirty-five pounds a week to watch the basic TV channels from a hospital bed; 60p a minute for a relative to call a patient on a hospital phone; a minimum of £1.80 for the car park for a short visit: these charges are happening at my hospital and at hospitals across the land. They are a tax on sickness and a particular tax on long-term sickness. They have to stop.
Jonathan Ashworth
My hon. Friend has hit upon a brilliant new campaign, which I am sure she will be running. The charges for watching television in wards are absolutely extortionate. It is a scandal; it is a tax on sickness; but it happens because the hospitals, and the health service in general, are so desperately underfunded.
Several hon. Members rose—
Jonathan Ashworth
I will take an intervention from Chesterfield and then I will make some progress.
Toby Perkins (Chesterfield) (Lab)
Chesterfield Royal Hospital is consulting on setting up a subsidiary company. Does it not seem madness that, to save £3 million that the hospital is paying the Government, it is creating this new organisation, which is being funded by the Government anyway? It is the emperor’s new clothes. The money is going round in circles without doing any good.
Jonathan Ashworth
In addition, hospitals have wasted millions in consultancy fees in setting up these organisations. They create a two-tier workforce because new joiners will not necessarily be on “Agenda for Change” terms and conditions, and they could at some point be completely sold off to the private sector. It is a back-door privatisation.
Several hon. Members rose—
Jonathan Ashworth
If Members will forgive me, I will make a little bit of progress, and then hopefully we will get a chance for more to come in later.
Labour has been calling for a long-term economic plan for the NHS. We are led to believe that the Secretary of State agrees with us, because according to The Guardian, in an article headed “Hammond and Hunt in battle over NHS funding boost”, the Secretary of State and Chancellor are reported to be “at loggerheads”, with the Secretary of State calling for £5.3 billion extra, but the Chancellor only wanting to offer £3.25 billion. Of course, neither is quite as generous as the extra £45 billion for the NHS and social care across the Parliament that Labour was offering, but we will watch carefully.
Our plans would have been funded from increasing taxation on the top 5% of the wealthiest in society. Perhaps the Secretary of State can tell us how he proposes to fund his extra £5 billion. Will it be an increase in national insurance for pensioners, as has been floated? Or will other Departments be cut? Will the defence budget be cut to fund the extra £5 billion increase in the NHS? Will it be a move towards co-payment and charges? Or will it be another conjuring trick from the Secretary of State, whereby he claims to be increasing the funds going into the health service, only for us to subsequently find out that public health budgets, training budgets and infrastructure budgets have been cut and the settlement is not quite as generous as we have been led to believe? According to tomorrow’s Spectator, there will be a Tory splurge on the NHS, so he should honour the House today with his confidence and tell us where he thinks this splurge will come from—tax rises, cuts elsewhere, or charges and co-payments.
I remind the right hon. Gentleman: it was a Labour Government with Gordon Brown who increased taxation to pay for the NHS and helped us treble funding in cash terms, and it will be the next Labour Government who will increase taxation for the very wealthiest in society to fund a long-term, sustainable plan for the NHS. When we face the demographic challenges of an ageing population, with people living longer, the disease burden shifting and people living with co-morbidities, and when we are on the cusp of great advances and innovations from artificial intelligence and genomics, is it not clear that the current fragmented structures of the NHS are wasting energy, wasting time and wasting resources?
We are now led to believe that, according to the BBC, the Prime Minister and the Secretary of State, despite both having sat in a Cabinet that agreed the Health and Social Care Act 2012, have realised that the structures produced by that Act have been a dismal failure. I do not like to say, “We told you so,” but we did actually tell you so. The Act has created a fragmented mess, with healthcare leaders trying to work around it. I say to the Secretary of State that it does not need amending—it simply needs consigning to the dustbin of history to be included in the next edition of “The Blunders of Our Governments”.
We will test any new legislation that the Secretary of State brings forward to see if it moves towards greater collaboration—away from a purchaser-provider split model in favour of partnership and planning. Any new legislation should bring an end to the creeping, toxic privatisation of the NHS and instead restore and reinstate a public universal national health service. The Health and Social Care Act has contributed to the reality today where, according to the Department of Health’s own figures, £9 billion is spent on private providers—a doubling in cash terms since 2010. Indeed, we have seen about £25 billion of contracts awarded through the market since the Act came into force.
Of course, there has always been a role for the private sector in providing services, as I said to the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, as indeed there has always been a role for the voluntary and co-operative sector. But the combination of years of underfunding alongside the constant tendering of contracts via the any qualified provider arrangements has led to creeping privatisation. Before Government Members tell us that this is just 8% of the total budget—in fact, the Secretary of State told the House in January that it is “not huge”—let me point out that the problem is that that 8% is located almost exclusively in areas like elective care, community services and patient transport, meaning that the private sector is disproportionately influential in those areas. Moreover, the way in which the funding mechanism works restricts NHS income from those areas and leaves NHS providers picking up the more complex, costly cases—emergencies and the chronic sick. In other words, outsourcing and privatisation is increasingly a false economy where supposed savings are easily outweighed by the costs.
But more importantly than that, privatisation has first and foremost a detrimental impact on patient care.
Maria Caulfield
Does the hon. Gentleman not agree that the any qualified provider system was brought in under the previous Labour Government in 2009?
Jonathan Ashworth
I remind the hon. Lady, whom I greatly respect in this House because of her work in the NHS, that we moved away from that system to a preferred provider mechanism because we knew that the any qualified provider mechanism did not work and was not in the interests of patient care or the interests of the taxpayer.
Let me give some examples. On support services, GPs have warned repeatedly of the dangers of NHS England outsourcing primary care services to Capita, in a contract designed to save £40 million. Those fears proved well founded, as the National Audit Office found that there was a real risk of “serious patient harm” stemming from Capita’s handling of the contract, with major problems around the secure transfer of patient notes, with notes going missing or delivered to the wrong surgery. Capita’s work in providing back-office services such as payment administration, cervical screening tests, medical records and supplies orders had fallen
“well below an acceptable standard.”
On patient transport contracts, I mentioned to the right hon. Member for Mid Sussex (Sir Nicholas Soames) what happened with Coperforma. This was a contract worth £63.5 million.
Jonathan Ashworth
And the CCGs are still paying out to Coperforma—is that not correct?
Maria Caulfield
With regard to Sussex—I am sure that my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) would agree with me—the last time Labour was in government it proposed to close the Princess Royal Hospital in Haywards Heath.
Jonathan Ashworth
I am sure that the hon. Lady accepts that it is a scandal that the CCGs—her local health economy—are still paying out to Coperforma. She should be getting up and complaining about that.
What about support services? Interserve was brought in to provide facilities management across 550 NHS buildings across Leicestershire, with a seven-year, £300 million contract. The contract was scrapped four years early because of reports of patients receiving meals up to three hours late, bloodstains in the corridors and bins not emptied. How about Carillion, which won a £200 million, five-year estates and facilities management contract with Nottingham University Hospitals NHS Trust? It failed to clean the hospitals properly, with reports that infectious waste was seen overflowing in the children’s ward.
Vernon Coaker (Gedling) (Lab)
The concerns that my hon. Friend is raising are the same as those raised by the Chair of the Health Committee in a letter to Sir Simon Stevens, chief executive of NHS England, in which she said:
“My central concern is that contracted services can seemingly fail to meet the basic clinical requirements without being held to account or compelled to acknowledge and remedy their failings. This risks undermining the effective commissioning of services and could, ultimately, compromise patient care and safety.”
Jonathan Ashworth
My hon. Friend, who is extremely experienced, shows with great eloquence the dangers of this relentless outsourcing of services. It damages patient care and is not in the interests of the taxpayer.
Helen Whately (Faversham and Mid Kent) (Con)
I thank the hon. Gentleman for giving way. I remember well when I worked in the NHS under a Labour Government, before I was a Member of Parliament. All around me was talk of independent sector treatment centres, offering more choice through bringing in more private sector provision to the NHS, and PFI contracts. That was under the previous Labour Government, who I believe were trying to make the NHS give better patient care, but Labour has changed its tune. I am concerned that this seems to be all about ideology. I care—
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. Members cannot make speeches in interventions.
Jonathan Ashworth
I greatly respect the hon. Lady, and I greatly enjoyed her Red Box blog on mental health provision last week. I know she thinks carefully about these matters, but this is not about ideology. It is about what works. Let us take the example of the East Kent contract for integrated NHS 111 and GP out-of-hours services, which began in January 2017. After only seven months of Primecare running it, the service was placed in special measures after it was rated inadequate. That is happening in her own backyard. This is not working, and that is the point we are making.
The history of PFI is that when we came into government, a third of hospitals were more than 50 years old. That is why we carried on with the John Major PFI scheme, which was the creation of that Government. Current Cabinet Ministers such as the shadow Health Secretary at the time, now the Secretary of State for International Trade, stood at the Dispatch Box and congratulated the Labour Government on taking up the private finance initiative developed under the previous Government. He said he would not object to the use of PFI
“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]
In this House, the current Chancellor of the Duchy of Lancaster gave a “warm welcome” to a PFI in his own constituency. The Brexit Secretary said in this House:
“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]
The Business Secretary said:
“PFI was initiated by the previous Conservative Government”—[Official Report, 12 February 2013; Vol. 558, c. 787.]
The Scottish Secretary has said that PFI is a “successful basis for funding”. The Welsh Secretary said:
“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]
We will take no lessons from the Tories when it comes to PFI.
We have not only seen facilities management contracts having to be brought back in-house in Leicestershire and Nottingham; we have also seen them deliver a poor quality of service across Lewisham and Greenwich. Those contracts at Lewisham Hospital should come back in-house. I know that the Labour candidate in Lewisham East will be campaigning to bring them back in-house, and I hope the Tory candidate will do the same.
Jonathan Ashworth
I will give way to my hon. Friend from Lewisham, and then I will make progress.
Vicky Foxcroft
I thank my hon. Friend. He is right: the candidate in Lewisham East will absolutely be campaigning on that, because it is out of order and outrageous that many of the people working under that contract are not receiving pay for one week because Interserve is not paying them.
Jonathan Ashworth
Absolutely. I wish the Labour candidate in Lewisham East well and will be campaigning with them. We will be sending a firm message to the Tories that privatisation of the NHS will end. The NHS is not for sale.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Will the hon. Gentleman give way?
Jonathan Ashworth
I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.
Rachael Maskell
I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?
Jonathan Ashworth
My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.
I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.
Mr Deputy Speaker (Sir Lindsay Hoyle)
It is not about my patience, but about Back Benchers.
Liz Saville Roberts
I have only one question: will the hon. Gentleman explain why the Welsh Labour Government have outsourced dialysis services at Wrexham?
Jonathan Ashworth
We have always said that there is a small role for the private sector. This is what I said earlier—[Interruption.]
Mr Deputy Speaker
Order. I want to hear Members on both sides, and I certainly want to hear the answer, but I cannot do so if everybody is shouting.
Jonathan Ashworth
We have always said that, and I do not know why Government Members are so surprised about it. Indeed, the Prime Minister, thinking she had a humdinger, quoted me at Prime Minister’s questions, but I was decidedly nonplussed by her response to my right hon. Friend the Leader of the Opposition.
Perhaps the biggest area in which private contracts have gone out is in community services, where the private sector has taken over 39% of contracts compared with the 21% in the NHS. NHS Providers said last week:
“The fragmentation of the community sector is…due to the private provider share of the community…service market being much larger than in other sectors”.
It also said:
“it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.”
We have seen this time and again. For example, Serco was awarded a £140 million contract in Suffolk, but could not meet key response times, such as the four-hour response time for nurses and therapists to reach patients at home 95% of the time. Before Serco took over the contract, the target was achieved 97% of the time.
Jonathan Ashworth
I did say that I would not take any more interventions. I apologise to my hon. Friend; I know her intervention would have been excellent.
How about the seven-year contract worth £70 million per annum to Virgin Care that was awarded in November 2016 across Bath and Somerset, with services including health visitors, district nurses, speech and language therapists, occupational therapists, physiotherapists and social workers? The first few months were beset with IT problems, and there were problems with payroll transfers and delays in paying staff. How about the dermatology contract in Wakefield, which again went to Virgin Care? The IT systems did not work, and it was not consultant-led. Satisfaction fell by so much that GPs refused to refer, and again the contract had to come back in-house.
In fact, Virgin Care is now picking up over £1 billion of NHS contracts, and when it does not win a contract and believes something is wrong with the tendering process, it becomes increasingly aggressive in the courts. Most recently, and disgracefully, it sued the NHS in the Secretary of State’s own backyard and forced it to pay out £1.5 million. That money should be spent on patients in Surrey, not go into the coffers of Virgin Care.
The legal action by Virgin Care reveals a bigger truth. Not only does the Health and Social Care Act lead to many community health contracts going to the private sector, but the regulations underpinning the Act are dysfunctional, which results in millions being wasted on increasing numbers of failed privatisation projects. Perhaps the most prominent example is the 10-year contract worth £687 million for end-of-life and cancer care in Staffordshire that has had to be abandoned, costing CCGs over £840,000—money that should have been spent on patients.
That is why we are raising concerns about the proposed accountable care organisation model, which is currently subject to judicial review. We favour integration and accountability, and we agree that services should be planned around populations and, indeed, that funding should be allocated by means other than an internal market. We favour a strategic hand in the delivery of services and greater local collaboration, and our vision is one of planning and partnerships.
However, the existence of piecemeal contracts and the contracting out of services is a major barrier preventing the real integration of health and social care. The enforcement of competition obstructs collaboration and the proper, efficient organisation of services. A model in which billions of pounds of NHS and local authority funds can be bundled up and go through a commercial contract for 10 years is not accountable and neither, depending on the level of funding, will it deliver the level of care we expect, while it could also go to the private sector. What sense does it make to offer binding long-term contracts for delivering a vast range of services over 10 years? Surely the lesson of PFI is not to guess the future, not to write healthcare contracts for services 10 years hence and not to get locked into a deal when so much will change in the delivery of healthcare over the next 10 years.
This is a tired, outdated, failing approach. Quite simply, privatisation has failed. Almost every day in the NHS, we hear of a further investigation, a further failure, a contract handed back or a problem uncovered—from scandalous failures in patient transport, to poor standards in private hospitals, to millions wasted on huge tendering exercises that go nowhere, to Circle failing to manage Hinchingbrooke, to Capita failing to manage vital patient records, to Interserve failing to clean hospitals and deliver meals, to Virgin Care suing the NHS for £1.5 million.
I challenge the Tories to point in this debate to a significant success in outsourcing to offset that total mess. No Tory can tell us that the competition and markets in the Health and Social Care Act have led to shorter waits, innovations in care or better services. The reality is that the NHS and the provision of healthcare are too important to be left to the chasing of market forces. The principles on which our NHS was founded seven decades ago are being betrayed by this Government, and the staff and patients of the NHS are being betrayed with it. There are longer waiting times, intolerable pressures on staff, daily stories of human heartbreak and operations cancelled.
On the 70th anniversary of the NHS, the staff can hold their heads up high, but the Government should bow their heads in shame. In this anniversary year, it will fall again to this party—the party that founded the NHS and that believes in the NHS—to rebuild and restore a public universal national health service.
Several hon. Members rose—
Mr Deputy Speaker (Sir Lindsay Hoyle)
Hopefully we will get some Back Benchers in, but I warn them that they will get no more than four minutes each. That may have to come down and some Members may not get in.
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I welcome the opportunity of this debate to dispel some particularly pernicious myths.
May I say how much I enjoyed the shadow Health Secretary’s speech? If they had listened to his denunciation of privatisation and outsourcing, I think my children would have said that Alice in Wonderland has nothing on the Labour party when it comes to taking totally contradictory positions on an identical issue. My favourite thing was the stirring way in which he said, “What concerns me most is contracts handed out that are poor value for taxpayers,” after his Government left £80 billion-worth of PFI contracts for the NHS to pick up the pieces. That costs the NHS £2 billion every year—money that cannot be used for good patient care. He had lots of other gems and we will return to them during the course of this speech.
I want to start with the motion. I am afraid that it is a transparent attempt to set hares running about NHS privatisation that is not happening. He used the phrase “creeping toxic privatisation”, but the truth is that we know it is not happening and the Opposition know it is not happening. With all the pressures facing the NHS today, to scare staff and the public with fake news is breathtakingly irresponsible.
In the motion, the Opposition use the Humble Address mechanism to ask for the release of documents, knowing full well that it will fuel wild conspiracy theories if we refuse to release those documents, as we must for reasons that are nothing to do with the NHS, but to do with good governance. However, there is a flaw in their Machiavellian logic. When I asked officials for advice on what submissions we as Ministers hold on privatisation—this great swathe of secret plans that the Opposition constantly allege—this is the written advice that I got back: “Officials have, since the Humble Address was received, sought to find submissions about the privatisation of clinical or patient services within the period specified, but to this point none have been identified. Her Majesty’s Government has no plans to privatise the NHS.” That was the official advice, but don’t take it from me. The respected King’s Fund said in 2015 that
“claims of widespread privatisation are exaggerated.”
Another way in which the Labour party loves to try to scare the public is to deliberately muddle up privatisation and outsourcing, which of course are quite separate. I think the shadow Health Secretary knows that, going by some of his comments. What are the facts on outsourcing? The Prime Minister did indeed wax lyrical about the possibility of 40% of acute operations in the private sector being done under the NHS banner—not this Prime Minister, but Tony Blair in 2006. Had we followed Tony Blair’s advice, we would be spending nearly £2 billion more on outsourcing than we currently spend. The Secretary of State from that period also said quite openly, “We intend to use the private sector when it can bring expertise or resources to help improve services.” That is not me, but Alan Milburn in 2002.
And boy, did team Labour set about that outsourcing with enthusiasm: not just increasing the PFIs we have talked about and not just giving the first contract for an NHS acute hospital to the private sector in 2009—that was Andy Burnham—but increasing the amount spent on outsourcing by 50% in the last four years of that Government. [Interruption.] Fifty per cent. These are the facts. I know the hon. Member for Dewsbury (Paula Sherriff) wants to do the fake news and the scare stories, but let us just listen to the facts. Let us talk about what has been happening under this Government. In my first year as Health Secretary, the proportion going to the independent sector went up by 0.6%. In the second year it was 1.2%, in the third year it was 0.4% and last year it was 0%.
I need to correct the record. During Prime Minister’s questions, I hurriedly passed the Prime Minister a note about the increase in Wales in the use of the independent sector. She said at the Dispatch Box that in Wales it had gone up last year by 0.8%. I need to correct that, because in fact it went up by 1.2%—50% more than I thought. Wales, where Labour is in government, is racing ahead. In fact, in pounds spent, the use of the independent sector last year in Wales went up by a third. What that shows is not just that these allegations are nonsense, but that Labour knows they are nonsense. If there was any truth to them they would not be increasing outsourcing in Wales by one third at the same time as branding it as verging on the criminal in England. With the huge pressures facing the NHS and immense efforts by frontline staff to cope with flu, winter and an ageing population, can the Labour party really be trusted with the NHS when it spends its time putting out fake news?
Unlike Labour, we do not believe that the NHS should close its ears to innovation in other sectors or other countries. We want the NHS to be the best in the world and there are things to learn from others that will help patients and help the NHS. Sometimes those innovations will even come—dare I say it?—from America. But to copy global best practice from one small part of what is happening in America does not mean that we want to copy its system itself, which I think, and I think most people in this House think, is an affront to that great country, with poor outcomes, lack of coverage and high cost.
To stop ideology trumping the needs of patients, the Conservative-led Government in 2012 legislated to stop politicians choosing whether to boost the private or the public sector, formally and legally giving that decision to clinicians who run clinical commissioning groups. I will tell the House why we did that. What would happen if we followed what the shadow Chancellor advocated last year, when he said
“we will reverse Tory privatisation by renationalising the NHS”
is that 120,000 people would have to wait longer for operations on their hips, knees and for other elective surgery. The price of Labour ideology, putting ideology before patients, would be nearly 200 people waiting longer in every constituency in this House.
Julian Knight (Solihull) (Con)
The Secretary of State touches on a point that is very pertinent in my constituency. I met a former police officer who had an NHS operation on his hip. The operation went wrong, so the local NHS trust paid privately for the officer to have the operation done correctly. Does that not show that at times it can be a very good thing to involve the private sector? The key is that the NHS is free at the point of need.
Karin Smyth (Bristol South) (Lab)
I am listening carefully to the Secretary of State’s comments on ideology and the Health and Social Care Act 2012. He will remember that I, in a CCG, was implementing the 2012 Act. Is he saying that he is proud of the Act and that it has worked out as intended?
Mr Hunt
As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.
As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:
“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—
[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:
“The National Health Service will include family doctors”
and will
“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.
Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—
Jonathan Ashworth
I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.
Mr Hunt
As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
The circumstances around the recent collapse of Carillion have left Liverpool with an unfinished hospital. Negotiations with a potential new contractor are under way but may require ministerial involvement because of the involvement of other Departments. Will the Secretary of State give me an absolute assurance that he will do whatever he can within his power to ensure that that new hospital is completed as soon as possible?
Mr Hunt
I can give the hon. Lady that assurance. I am most grateful to her for raising that issue and reassure her that my hon. Friend the Minister of State responsible for hospitals was at the hospital on Friday, going into detail about how we make sure that there are no delays on that issue.
Jamie Stone
I thank the Secretary of State for giving way. On the issue of freedom of access and equality of access, would he at least concede that where there are issues of distance, rurality and remoteness of location, that is a challenge—although health is devolved to the Scottish Parliament—which means that it is not quite as free for some of my constituents as it is for people who live in Glasgow, Edinburgh or London?
Mr Hunt
The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.
There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.
Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.
On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.
Mr Hunt
No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.
Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.
There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.
This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.
No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]
Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.
Mr Hunt
My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.
I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.
For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. As colleagues will see, a vast number of Members want to speak in the debate. I will impose a four-minute limit after we have heard from the spokesman for the Scottish National party.
Chris Stephens (Glasgow South West) (SNP)
I will be as brief as I can, Madam Deputy Speaker, to accommodate Members with clear constituency interests who I know will want to contribute to the debate. It was interesting to watch the Secretary of State being the pantomime villain of the day and trolling us about the Conservatives’ record on the national health service.
I want to make some observations about privatisation and outsourcing in particular. I think that I should start off with the World Health Organisation’s definition of privatisation:
“a process in which non-government actors become increasingly involved in the financing and provision of health care, and/or a process in which market forces are introduced in the public sector”.
Patients who attend health service centres throughout these islands will receive amazing care, but that is predominantly due to the dedication of the people who work in the NHS, some of whom—as we need to recognise—are working under much greater pressures than others.
Some have argued that outsourcing such services as cleaning or car parking is a good thing, but there is evidence that the outsourcing of cleaning, and poor-quality cleaning, led to the rise of hospital-acquired infections. The Conservatives created the internal market in 1990, and that led to an “us and them” mentality in many local areas because it introduced competition between hospitals. In 2010, they promised “no top-down reorganisation”, but then introduced the Health and Social Care Act 2012, section 75 of which pushed commissioning groups into putting contracts out to tender.
We have seen the rise of the independent treatment sector, which won approximately 34% of contracts in 2015-16. That figure rose to 43% in 2016-17, and it now stands at approximately 60%. It cannot be denied that private companies are more involved in healthcare in England.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
Will the hon. Gentleman give way?
Chris Stephens
I am sorry, but I will not take any interventions because many Members with constituency interests wish to speak.
We often hear about the costs of service redesign. The new organisations, the external consultants and the change managers are all described as one-offs. However, the experience of NHS workers over the past 30 years is that the process has led to a huge amount of waste.
Chris Stephens
The hon. Gentleman is right: many Members representing English constituencies want to talk about their constituents’ experience, and I think it only fair to allow them to do so—[Interruption.] The hon. Gentleman can try all he likes, but I will not be shouted down by anyone in this Chamber.
What about running costs due to market forces themselves? What about the contracting design, the tendering, the bid teams, the corporate lawyers, the billing and the profits? The Government appear to have moved from an internal market to the external market that is now in England. [Interruption.] Members keep trying to shout me down, but I will continue talking. It is disrespectful to shout Members down in this Chamber. I will continue my speech, but I want to accommodate other Members. I do not think that they should be subject to a four-minute time limit, and I want to give them time to talk about their constituents.
A petition that received 237,095 signatures was debated in Parliament in April. The signatories are very concerned about outsourcing in the NHS, and they have every right to be concerned about the approach of this Administration. Others have warned of the threat of English health privatisation as it applies to devolved services. The trade union Unison has warned:
“The Tories might not run NHS Scotland, but that doesn’t mean they aren’t attacking it. We must fight to save it.”
It also says:
“Devolution means they can’t run down and privatise our NHS directly, the way they are doing in England”,
but what the Tories can do is starve it of resources. The NHS is under threat from privatisation and cuts. The Tories’ health Act pushed the profit motive to the heart of the English national health service.
I hope that the Minister will address a number of things mentioned by the hon. Member for Leicester South (Jonathan Ashworth) when he responds to the debate because I find what has been happening astonishing. I opposed outsourcing and privatisation before I was in this place, as a trade union activist for 20 years. The issue of West Sussex has been mentioned, but we have heard no response. We have also heard about Carillion—I was on the joint inquiry into Carillion—and the effects of what happened on Liverpool. We heard about the collapse of the £800 million contract in Cambridgeshire and Peterborough for older people’s services.
Those issues are all serious, and people across the UK who are watching our proceedings will be concerned about the outsourcing and privatisation of the NHS in England—[Interruption.] I will not be shouted down. The Scottish Tories think that they can shout people down, but that will not happen with me. I am reaching the conclusion of my remarks, so the hon. Members for Berwickshire, Roxburgh and Selkirk (John Lamont) and for East Renfrewshire (Paul Masterton) will have to be patient until another day.
Those who are watching these proceedings will be very concerned about the outsourcing and privatisation of the national health services in England. People want to see a publicly owned national health service across these islands.
David T. C. Davies (Monmouth) (Con)
I am sure that my hon. Friends the Members for Berwickshire, Roxburgh and Selkirk (John Lamont) and for East Renfrewshire (Paul Masterton) were simply trying to find out why the hon. Member for Glasgow South West (Chris Stephens) did not want to talk about the £70 million-odd a year that the SNP Government in Scotland are spending on outsourcing, but we will leave that for another day.
I was delighted that my right hon. Friend the Secretary of State mentioned Henry Willink, the former Member of Parliament for Croydon North and war hero, who was one of many people who helped to form the national health service, along with the great Liberal Beveridge, of course. It is disappointing that Labour have tried to make the NHS something that they alone feel they have the right to talk about. It is not their NHS; it is our national health service. It does not belong to any one political party; it belongs to all of us. There was opposition from a number of Conservatives to the Bill that set up the NHS, but some Labour peers, such as Lord Latham, and Herbert Morrison were concerned about that Bill, although of course all that is written out of history.
We know that whenever the Labour party is in trouble, it starts to generate scare stories about privatisation. We have been thinking about the celebrations for the anniversary of the national health service, but I was rather sad last year about another NHS anniversary: 30 years since Labour started making up mythological stories about the Conservative party wanting to privatise the NHS. It was 30 years since 1987, when Labour said that they would end “privatisation in the NHS”. They did the same thing at the ’92 election, saying:
“Labour will stop the privatisation of the NHS.”
And so it went on at one election after another: Labour trying to conjure up the idea that the Conservatives wanted to privatise the NHS. Despite that, we won numerous elections after 1987—we have been winning them since 2010—and we have absolutely no intention of privatising the national health service and never will.
It was interesting that Labour’s 2005 and 2010 manifestos said that a Labour Government would start using the private sector. The 2005 manifesto talked about using the “independent and voluntary sector”, and that approach continued in the 2010 manifesto.
As a result, between the financial years 2006-07 and 2013-14, we saw a gentle increase in the amount spent on the private sector within the national health service to deliver operations free at the point of use to those who need them by occasionally using private contractors, as the SNP is doing in Scotland. The figure went up from 2.8% to something like 6.1%. To put those figures in perspective, Cuba—a country I love, but not one known for its wild capitalist economy—has about 18% of its production in the private sector. Figures from an obscure website, thediplomat.com, suggest that 7.5% of North Korea’s economy is in the private sector. In other words, North Korea makes greater use of the private sector than the NHS—a figure of 6.1% does not represent privatisation.
From my experience, I can truthfully say that I have a complaint about the NHS in England, and so do my constituents: we cannot access it, because we are forced to use the national health service in Wales. The result of our having to use a health service that has been under 18 years of Labour government is that we have longer waits for our ambulances. I recently dealt with a case of a lady who had to wait two hours for an ambulance after a suspected heart attack. We have longer waits for accident and emergency. We do not have access to cancer drugs such as Avastin in the way patients do in England. And, of course, we wait much, much longer for hospital treatment and operations. The target in Wales is 26 weeks, as opposed to 18 weeks, but that target is all too often missed.
I wish that I had more time to talk about Labour’s failings in the national health service. I have suggested a few things in my time, but neither I nor any Conservative MP will ever privatise the NHS. It is about time the Labour party stopped telling those fibs.
Rosie Duffield (Canterbury) (Lab)
A few weeks ago, my local NHS trust in east Kent announced that more than 1,000 employees—more than 800 Serco employees and more than 200 NHS employees—working in cleaning, catering, estates and facilities will now be employed by an arm’s length management organisation.
Most of us in this House will be familiar with ALMOs, but for those watching, listening and reading about them for the first time, although ALMOs may sound a bit like that well-known cuddly Muppets character, they are nowhere near as fun. This is not “Toy Story” but Tory story, a story of endless austerity and endless cuts to our vital and much-loved health and public services.
ALMOs have become a mechanism by which primarily local authorities, but now it seems NHS trusts too, can avoid responsibility by keeping things such as housing departments and cleaning facilities at arm’s length—away from too much scrutiny, and away from the managers and councillors whose jobs might depend on keeping themselves as far away as possible from that scrutiny.
Judith Cummins (Bradford South) (Lab)
My hon. Friend is making an excellent speech. Staff in Bradford have real concern about the plans to create a wholly owned company that could see 300 members of staff at Bradford Teaching Hospitals NHS Foundation Trust transferred out of the NHS, creating a two-tier workforce. Does she agree that we need to keep our health service, in the words of Unison’s campaign, 100% NHS?
Rosie Duffield
Absolutely. I was just about to speak about Unison, which is my union.
Leading unions have called the move in my local NHS trust—the East Kent Hospitals University NHS Foundation Trust—a “wolf in sheep’s clothing” and fear, with good reason, that workers’ conditions, including pay, will be eroded. I know many of those workers personally and they include some of my friends. The unions are right: workers’ conditions will be eroded, and it is already happening in other public services across Kent.
The Conservative-run Kent County Council, for instance, has introduced another ALMO called the Education People. Educational psychologists currently working directly for the council are being transferred to be employed by the Education People. The terms and conditions being offered by the ALMO to new educational psychologists are significantly worse than existing terms and conditions for those employed by the county, so no new educational psychologists have been recruited for Kent. We already have a serious shortage.
Of course, Kent County Council is doing that because central Government have starved it of funds and, perhaps because it is the same shade of blue, it is too timid to make that big a noise about things, so I will do it instead: Conservative central Government cuts are reducing our ability to care for people properly. In my constituency, the local NHS is potentially doing the same by setting up an ALMO to make yet more cuts by stealth. More money, less responsibility.
My union, Unison, represents nearly half a million healthcare staff employed in the NHS. That is one in every 60 or so working adults in one sector in the UK represented by one union standing up with one voice against injustice.
In Canterbury, rooms at the once thriving city hospital can now be found stacked with old equipment, and staff tell me that whole wings of old, neglected hospitals, such as the Buckland in Dover, lie abandoned, underused and under-occupied while waiting rooms in our not-so-local accident and emergency departments remain rammed. In Canterbury, services that were removed “temporarily” in 2017 look likely never to return to those old buildings. Proposals are afoot for a new hospital, but it simply will not be built if the central Government funding is not there to fill it. I am the only Labour MP in Kent and, as such, I am proud to make a loud noise about and stand up against the Conservative cuts that have caused vital hospital services to disappear in my county in recent years.
Things need to change drastically, and the new university medical school in Canterbury will be part of that much-needed change. If someone in my constituency is sick, they currently have to travel a long way to Ashford or Margate to get the emergency care they need.
Combine an underfunded NHS with a South East Coast Ambulance Service in special measures, and we have the ingredients for chaos. Chaos and a lot of sadness are apparent in all the letters I receive from constituents about the NHS week in, week out. Members will get the idea. The funding is not there, so the services have gone.
Helen Whately
I have a question about what the hon. Lady said regarding the loss of services at Canterbury Hospital. She and I both oppose that. Does she acknowledge that services were lost under a Labour Government?
Rosie Duffield
I agree that services started to be cut under a Labour Government, but they have got so much worse that our hospital is now underused, unusable and unrecognisable.
Madam Deputy Speaker, you will hear the same thing repeatedly from my concerned Labour colleagues this afternoon. The impact of austerity on our health service has been truly dreadful. Trusts are beginning to look to PFIs to keep walls from crumbling, and the desire for a short-term fix has meant that private companies, such as Virgin, Serco and Spire, have stepped in, especially near me in Kent, to profit from sickness, which is fundamentally abhorrent.
So much must change. The privatisation of the NHS and supporting services must be stopped and funding must be fully restored to the levels it was at under the last Labour Government. If Conservative Members continue to erode our health service and encourage private companies to step in to fill in the gaps, there will be little left when they finally realise what they have done. With so many pieces given away, the NHS jigsaw will certainly never look the same again.
Labour Members are constantly accused of running down, criticising and putting down our health service. The fact is that we are telling the truth about the urgent state of our broken NHS, which is staffed by amazing, dedicated and selfless people who deserve so much better from this Government.
Tom Pursglove (Corby) (Con)
It is a pleasure to follow the hon. Member for Canterbury (Rosie Duffield), but I come at this debate with a real sense of frustration, because the NHS is once again right at the heart of political knockabout, which does absolutely nothing to advance the cause or to pursue better patient care. I am frustrated that the word “privatisation” is so readily bandied around for cynical ends to scare the public and to try to give a misleading picture of what is happening for dogmatic reasons.
Nobody is seeking to privatise the NHS, but it was Labour that introduced competition into the NHS. What does that mean? It means that there is often greater capacity to treat people more quickly based on demand. What could possibly be wrong with buying in 100 hip operations, for example, if people get treated more quickly, if they are getting the best possible care and if they are fit and well sooner? Who could possibly argue with that? Not a single constituent of mine would argue that there is anything wrong with that. Surely they matter most in all this.
Labour Members hark on about money and not about outcomes—we do not hear anything about outcomes; we hear just about money, often in crude terms. A more effective debate today would have been about moving the agenda forward. We could have talked about things such as prevention. I am all for discussing prevention—at Prime Minister’s questions today, I talked about prevention through the daily mile, which would be a welcome step. In a time of increasing demand, prevention means that we are able to provide better care and that people do not get into desperate situations. It is often more effective for the taxpayer. Prevention means that people will be fitter and healthier for longer, which we should focus on.
The Government have consistently increased health spending year on year since 2010. I would be happy for a Labour Member to intervene and answer this question. Why have they not supported this Government’s increases in health spending? Could they say which services would have less money if we had taken their advice, given that we would be starting from a lower base? Back in 2010, the former shadow Health Secretary, who is now metro Mayor of Manchester, said:
“I am putting the ball right back in…Osborne’s…court. It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting.”
On the prevalence of private providers in the health service, currently less than 8% of the NHS budget is spent via private providers. The rate at which that has increased since 2010 has been slower than the rate under the Labour party, under whose Administration the NHS spent around 5% on private providers. The motion is a bit churlish. It does not focus on what we should focus on, which is patients, better care and moving the agenda towards the direction of prevention.
It frustrates me enormously that we use terms such as privatisation so readily, while knowing full well that they give a misleading picture to the public. We hear a lot of complaining from Labour Members, but, as with police and local government funding, and stamp duty for first-time buyers, when the Government find solutions, Labour Members vote against them. People will make their own minds up.
Liz Twist (Blaydon) (Lab)
On 6 March, I had the good fortune to secure a debate in Westminster Hall on wholly owned subsidiaries in the NHS and was shocked to find how many hon. Members—they were not just Labour Members—had experience of local NHS trusts setting them up. The NHS trust that covers my constituency, the Gateshead NHS Foundation Trust, has set up a wholly owned subsidiary company. It is also advising other trusts on how to do the same.
The Gateshead NHS Foundation Trust is a very good trust, but I am concerned that it has transferred staff who provide the maintenance, cleanliness and operation of the hospital to a wholly owned subsidiary company. There are two ways in which trusts can save money by setting up a subco: through savings on VAT thanks to a loophole—the Treasury appears to be willing to look the other way—and through future savings in staffing as new staff are employed outside “Agenda for Change” pay, terms and conditions. Importantly, there are also savings on pensions because those staff are denied access to the NHS pension scheme.
The savings are coming off the backs of staff, many of whom—porters, cleaners and catering staff—are already on the lowest scales. “Agenda for Change” was introduced to provide a fair and equality-proofed pay system for all NHS staff. It is bad enough that staff working for contractors in the NHS, such as those formerly employed by Carillion and now employed by companies such as Serco, which took over some of Carillion’s contracts, are not on that pay system, but the fact that NHS trusts voluntarily and even eagerly take measures to get around the system is simply outrageous.
Let us be clear: we know the problem is underfunding of our essential NHS services. This Government have failed to provide adequate funding right across the NHS and some trusts have taken the decision to set up these subcos in an effort to make that money go further. We understand that on the Labour Benches. But it is beyond the pale to ask lower-paid staff to make the savings from their own pay packets. All of us, on both sides of the House, say how much we value the NHS workforce, but that means not only nurses and doctors, but the staff who make the hospital work. They are an essential part of the NHS team, and the Government must ensure that they are treated fairly, now and in the future.
There is another concern about these subcos. There is a real concern that they are being set up ripe and ready for privatisation: a neatly packaged organisation, vulnerable to the vagaries of the market. This is not the NHS we want. We want an NHS that recognises the value all of its staff, from cleaners and porters to allied health professionals such as occupational therapists and radiographers, from maintenance staff to nurses and, yes, doctors. We need an NHS that does that so that we can provide the best possible care for patients. We need to ensure that we maintain these services in the public sector, and I know that there is huge support from my constituents for ensuring that our NHS services are directly provided by NHS staff.
Earlier today we heard that staff at Wrightington, Wigan and Leigh NHS Foundation Trust are taking industrial action against a proposal to transfer them to a subco. More than that, they are striking against the privatisation of NHS services. I wish them, and staff in other trusts standing up for our NHS, every success.
Alex Chalk (Cheltenham) (Con)
The allegation of privatisation of the NHS is wholly misconceived. It is a reheated and debunked myth that irresponsible elements have been trotting out for decades, and repeating it does not make it any more true. NHS outsourcing to private providers is being weaponised in a way that involves dressing it up as a threat to the NHS’s guiding principle that treatment should be provided free at the point of use and regardless of ability to pay. That is what people understand when the expression “privatisation” is used, but the reality is that nothing could be further from the truth.
That principle is fundamental, inviolable and enduring. It is all those things because it reflects so much about the kind of country we are and want to continue to be. It is the principle that says that when a member of the public is rushed into hospital needing emergency care, we take pride in the fact that the ability to pay is irrelevant. NHS staff are interested in vital signs, not pound signs. There is no appetite in this country for the Americanisation of British healthcare. Even if there were, I could never support it, my colleagues could never support it and the Government could never support it. That is why it is so important that we make that position crystal clear.
On the issue of outsourcing, we must not rewrite history. As moderate members of the Opposition concede, certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. The same goes for dentists and pharmacists. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and for non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense; it would be daft if public money was diverted from frontline patient care in order to research and reinvent something that was already widely available.
That is why certain members of the Labour party have slammed this kind of argument as scaremongering. Lord Darzi, a former Health Minister, has been highly critical. In 2017, the shadow Secretary of State said on the “Today” programme that there may well be examples
“where in order to increase capacity you need to use the private sector”,
so this argument is completely misconceived. In 2009, Andy Burnham admitted that the private sector could benefit the NHS. As Labour’s Health Secretary, he said:
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]
Helen Whately
My hon. Friend is making the point extremely well that there is complete inconsistency in Labour’s argument on this point. Which of the various parts of NHS services that are provided by independent sector providers is Labour against?
Alex Chalk
My hon. Friend is absolutely right. I shall give three brief examples from my own constituency. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, assists with training for healthcare professionals and provided the UK’s first high-field open MRI scanner. Is the Labour party now suggesting that that should be ditched—that we should axe that fantastic facility in my constituency?
Secondly, the Sue Ryder hospice at Leckhampton Court is part-funded by the NHS and part-funded by charitable donations; again, is that for the axe under Labour? Thirdly, what about Macmillan and its nurses? It is a fantastic organisation, yet we have the extraordinary situation in which the Labour party says, “Macmillan is all right, but another provider is not.” What is the logic of the Labour position? What about Mencap? The list goes on and on.
Let me deal briefly with the second part of Labour’s motion, whereby it wants to ensure that all communications between Ministers and their officials are revealed. The reason why that is so bogus was explained clearly by the former senior Labour Secretary of State Jack Straw in a statement that was quoted with approval in the Chilcot committee’s report. He said that meetings in Cabinet
“must be fearless. Ministers must have the confidence to challenge each other in private. They must ensure that decisions have been properly thought through, sounding out all possibilities before committing themselves to a course of action…They must not be deflected from expressing dissent”.
What about advice given by officials in the form of memorandums and so on? What would Labour Members say to those officials about a motion that might result in the making public of the advice of professional civil servants—people who, of course, can never answer back themselves—that they thought was given to Ministers in confidence? As I have already indicated, it would also be completely inconsistent with the Freedom of Information Act 2000, which was introduced by a Labour Government. On both bases, the motion is misconceived, and I shall have no hesitation in voting against it.
Dr Paul Williams (Stockton South) (Lab)
I refer the House to my entry in the Register of Members’ Financial Interests: I work as a GP.
There may be people listening to this debate who work for private or voluntary sector organisations, providing services to patients or to the NHS. Most of them do a fantastic job. They are not employed by the NHS, but they do help our NHS, and I thank them for the work that they do.
When local people and local commissioners agree that it is in the best interests of local patients to use non-NHS services to deliver NHS care, that should sometimes be enabled. In the fields of medical technology and devices, pharmaceuticals, information management and many others, good private sector companies are working to support the NHS. But private sector involvement can also lead to a race to the bottom. When subsidiary companies reduce terms and conditions for workers, that is bad for us all; when privatised community services ignore the hardest-to-reach patients, that can widen health inequalities; and when private sector treatment centres cherry-pick the least-risky patients, do not contribute to training, and then expect the NHS to pick up the pieces when complications arise, the NHS loses.
All that is without mentioning the private Primary Care Support England contract, run by Capita. It is total disaster. The main function of support services is to enable clinicians to get on with the job of looking after patients, but GP registrars are not being paid on time, GPs are not added to performers lists, and one practice manager told me that it took four months and 16 emails to transfer a GP from being salaried to being a partner. This work needs to be taken back by the NHS; Capita has failed.
What vision do I think we should have for our NHS? I endorse the Government’s goal of integrated health and care services built around patients’ needs. That is the only way to meet the health challenges of this century. The Health and Social Care Committee, on which I serve, has looked in detail at moves towards the integration of care through sustainability and transformation plans, accountable care organisations and integrated care systems. We have seen real potential to improve the quality of care for patients, to make the strategic shift away from reactive care to proactive care and to transfer more NHS resources into keeping people well rather than just fixing them when they get sick. The need to bring together primary care, community care and social care has widespread support in the NHS, but we should do that within a health and care service, run by the NHS, owned by the NHS, and led by the NHS.
There are understandable concerns about the integration agenda being used to encourage more private sector involvement. The Government and NHS England say that that is not their intention, but speculation could easily be dispelled by legislating to make accountable care organisations—if they happen—NHS bodies. I am talking about NHS-owned and NHS-led organisations running health, and even care services, for whole populations. What a great legacy that would be, with procurement not being forced on commissioners, with the private sector being used only when it enhances the ability of the NHS to help patients and with no cherry-picking and no dilution of hard-won employment rights for any staff providing services to and for the NHS.
The Government should bring forward legislation to repeal section 75 of the Health and Social Care Act 2012; accountable care organisations should be cemented in primary legislation that makes them NHS bodies; and the Primary Care Support England contract should be brought back into the NHS.
Matt Warman (Boston and Skegness) (Con)
It is a privilege to follow the hon. Member for Stockton South (Dr Williams) who made a laudable and moderate speech. I dare to suggest that when people have serious frontline experience of our health service, as many in my own family do, they are less hyperbolic than those we heard from the shadow Front Bench. We should be clear that hyperbole harms our health service.
I do not for a moment think that we should pretend that there is no politics in the health service, but we should be clear that there are many things that unite us on this. I say that in large part because the situation in my own constituency of Boston and Skegness, where we have a serious and ongoing problem recruiting paediatric consultants and paediatric staff, has led to a number of public meetings, which have been both fascinating and somewhat disconcerting. I say that largely because the rhetoric of privatisation, of outsourcing, is something that I have confronted at first hand.
People genuinely believe that there is a long-term suggestion that an American model is coming to the UK. The effect of that is not simply to scare people, but when the vulnerable older person in Skegness, who often does not have access to a car and often does not have the deep-seated knowledge that the hon. Member for Stockton South has of the NHS, thinks, “You know, I shouldn’t go to my GP. The NHS is under huge strain. I shouldn’t cause a fuss. I shouldn’t make that appointment.” Later down the line, when he or she find themselves in a less healthy position, it is the fault of those of us who have used the NHS has a hyperbolic football. All of us in this place should be responsible when we talk about the health service. As we always say, and as those on the Front Bench have said, it is about patients, not politics.
I have been in those public meetings saying to my constituents that I believe that the trust in my own constituency is passionately committed to providing healthcare services for desperately ill children as close to home as possible. When I say that that trust is struggling to recruit, it is because it is struggling to recruit; it is because it is being honest. It is not because of some conspiracy theory at the top of the previous Government or of this Government, but because there are deep-seated problems that this Government are tackling with, for instance, the expansion of medical schools and the expansion of nurse training places. We should not, I gently suggest, be ideological about this stuff, and we should be responsible.
The shadow Secretary of State said that this is not about ideology, but about what works. The hon. Member for Stockton South also said that where private sector involvement enhances what can be provided by the public sector, we should be brave about saying that what makes patients healthier is in the taxpayers’ interests, it is in their interests and it is in our interests. So, while it is sometimes hard, in this adversarial Chamber, to calm down and look at the interests of our constituents, and although parliamentary theatre may be fascinating for Prime Minister’s questions and may be fascinating to us, I would like to hear an acknowledgment that the present Government are investing more than ever in the health service, are seeking to tackle the challenges of an ageing population and are seeking fundamentally to put patients first.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
I am pleased to be called to speak in this important debate.
In my constituency, local NHS services have been an issue of concern for some time. It seems that services are forever under threat and that our local trusts are always struggling. Dewsbury Hospital, which is in my constituency and serves my constituents, has seen a number of its functions move to Pinderfields Hospital. Its A&E has been downgraded, so that seriously ill patients are more likely to be taken elsewhere, and in recent weeks the Secretary of State for Health stepped in to prevent any potential closure of the A&E at Huddersfield Royal Infirmary. That was a welcome step, but our NHS services should not be in a position where such drastic changes to provision are suggested.
I, like so many colleagues in the House, am in awe of our hard-working NHS staff, and I know that, in the Mid Yorkshire Hospitals NHS Trust, they continue to go above and beyond in ever more testing conditions. I pay tribute to them, and also say to Ministers that in my constituency we want our NHS staff to remain NHS.
Just last week, the Mid Yorkshire Hospitals NHS Trust announced plans to move staff into a wholly owned subsidiary company—something that, as we have heard from my hon. Friend the Member for Blaydon (Liz Twist) and others, is part of a national roll-out. That subsidiary will run a considerable range of local NHS services and will be responsible for an enormous number of local staff. The announcement came with very little warning and no public engagement about the plans.
Once again, I reiterate that I appreciate and understand the pressures that are being put on NHS trusts by the Government, and Mid Yorkshire is no different; but for me, the decision to move to a wholly owned subsidiary company simply is not the right one. Opposition has already been growing. The trade union Unison has called the trust’s plans an “insult” to workers, and will be balloting its members next month over potential strike action—something that will leave my constituents concerned, but also frustrated, as this problem is avoidable. They will understand that to take people off NHS contracts, and thereby put them at the risk of a future where the terms and conditions of their employment are inferior to those of their colleagues, can only worsen the situation.
The good news is—I hope it is good news—that the decisions on whether the trust can go ahead with its proposals are not a done deal. The Secretary of State for Health and Social Care still has to approve the plans. I say to him and his colleagues that these staff, including cleaners, IT specialists, maintenance workers, help keep our hospitals safe and functioning. They have stuck by the NHS in extremely testing circumstances, throughout years of pay stagnation. I, staff and the unions know that it is not the right decision to go down this path—a path that could lead to a two-tier workforce, where two colleagues working side by side, doing the same hours, the same job, could end up taking home a different wage.
Let us do the right thing by NHS staff and local people, and consign this wholly owned subsidiary to the bin where it belongs.
Chris Green (Bolton West) (Con)
It is a pleasure to follow the hon. Member for Batley and Spen (Tracy Brabin) and so many other colleagues who have made excellent speeches from both sides of the House.
I should recognise at the start of my comments that this Government have, over the past eight years, been increasing spending on the NHS and have ambitions, and a determination, to continue spending on our national health service. I look forward to the Government’s introducing a new substantial multi-year funding plan, which will provide more certainty for the future and better enable the NHS to plan and invest.
Locally, only last year we saw the building of a new £40 million mental health hospital—Atherleigh Park. That demonstrates this Government’s commitment to supporting people with mental health concerns. I was really pleased to see that local investment recently. In Horwich, we have plans for investment in GP services, with a new centre costing £6.8 million. It is going to be delivered in the near future, and it will provide a far better service and far better accessibility for people living in Horwich. That commitment to spending—to the NHS—is there.
As the Secretary of State highlighted, during the second world war the Conservative party, along with other parties in Parliament, was committed to delivering a national health service to ensure that we got that improvement in people’s health right across the United Kingdom. It is worth noting that since the second world war the Conservatives have run the NHS more than Labour. That rather undermines these arguments about privatisation, because why has it not yet been privatised if we have run it more than Labour? As my hon. Friend the Member for Corby (Tom Pursglove) said, the rate of increase in privatisation was actually far higher under the previous Labour Government. Labour ought to reflect on its own record in government of the increasing rate of privatisation through PFI deals.
Ultimately, this is about what works: that is what patients want to see. I am concerned about the scaremongering being pursued by Labour Members. Most MPs, when they hear the talk about privatisation, would recognise that care will still be free at the point of use, with a different mechanism to deliver the same high standard of care through the NHS or a private provider. What many people at home would hear, though, is that they will have to pay for that care—that they will need to have their credit card with them and if anything happens they will have to pay extra money, in addition to paying their taxes and everything else. During last year’s general election, I had conversations with constituents who had been terrified by people on the doorstep telling them that they would have to get their credit card to pay for their healthcare. This scaremongering has to come to an end.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I rise to speak as a former public health consultant and the chair of a primary care trust.
I want to start by recalling a conversation I had with Brenda Rustidge, a constituent of mine. She was born in the 1930s, and she described to me what it was like living in a pre-NHS world. Her father, who had just been demobbed after the war, was unemployed. She had a number of brothers and sisters, and they used to have to hide under the window when the doctor’s secretary called round on a Friday night to collect the money. She described the real fear and shame that she felt as a result. Of course, all that changed nearly 70 years ago when the NHS was created. Brenda and her family have thrived because of that.
This debate is not about scaremongering. It is about raising awareness of the real concerns not just of political parties but of clinicians, academics and experts across the country and across the world about what privatisation means. Okay, it is on a small scale, but in terms of spending it has increased from about 2.8% in 2006 to over 7.5%—over 10% if we include not just private providers but all non-NHS providers.
I want to reflect on a point made by my hon. Friend the Member for Stockton South (Dr Williams): we have within the NHS a system that provides universal, comprehensive and free healthcare. That is something we should be very, very proud of. We are seeing that being eroded. For example, private providers of knee and hip replacements exclude certain people. They do not want the complex cases because they are too time-consuming and costly. I take issue with the point that the right hon. Member for Mid Sussex (Sir Nicholas Soames) made, because it does entirely matter who provides the care that we get. There is a slow and steady erosion of the NHS as the sole provider.
In 2014, I conducted an inquiry into the international evidence on the effect of privatisation, marketisation and competition across different health systems. We commissioned a review of reviews, which is the strongest type of evidence, on the impact on health services, particularly looking at equity and quality. It was submitted to peer reviews and accepted in peer-reviewed journals subsequently, and it showed clearly and conclusively that health equity worsens in terms of not only access to healthcare but health outcomes.
It also revealed that there is no compelling evidence that competition, privatisation or marketisation improves healthcare quality. In fact, there is some evidence that it actually impedes quality, increasing hospitalisation rates and mortality rates. Of course, that was the key argument and the sole reason that the Government put forward for the Health and Social Care Act 2012.
The report found a whole host of other issues. I am sure that Members will go to my website to read about that. The transactional cost was one example—
Huw Merriman (Bexhill and Battle) (Con)
It is a pleasure to contribute to the debate. I want to start by recognising the achievements of the Tony Blair Government in taking the ideology out of private-public, which was good, and fast-tracking a number of patients who had been waiting too long for knee or hip replacements by allowing those operations to take place using the private sector. My own family were able to benefit from that. That was a good example of looking at what was best for the patient. It was still free at the point of delivery and ultimately within the health system.
I find it deeply depressing to hear those on the Labour Front Bench this afternoon talking in a manner that completely unwinds that, putting the NHS as a political football first and what is best for patients second. The shadow Health Secretary was so excited about the concept that I thought he was going to spontaneously combust. It is a stain on the Labour party that it would go back in time in that manner.
Far from the exaggerations that we heard, the reality is that the proportion of private spend has gone up from 5% when Labour left office—not, as the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) said, 2.5%—to 8%. Since the NHS has been born, as GPs refuse to work within the NHS system, we have had private sector partnering. We have pharmacies. We have the pharmaceutical industry. The public and private have always worked together to make sure the patient gets the best outcome. I hope that somewhere along the line, the Labour party goes back to the formula that quite frankly got it into government and remembers that the public are not concerned about the politics. They just want to make sure that the NHS will be there for them in the fastest possible time, with the best care and free at the point of delivery—and that is what goes on at the moment.
We are seeing record levels of funding within the NHS, as we did under the Blair Government; I hope Members see that I am being fair and trying to make a cross-party point. I would like to see more funding in the NHS. While I do not like to see taxes go up—I would be the last person on the Government Benches to argue for that—I think the point has come when we need to look at our income tax rates and face facts. People are living longer, and they need better care. We need more money in our social care system as well.
As well as more money, we need reform. Reform only works when more money is put into the system. As well as seeing an extra 1p on income tax, I would like to see another penny effectively suspended. We can then go back to the public and ask whether they think it is acceptable that people abuse the A&E system and the people within it, and whether people should be charged if they turn up wrecked and take advantage. Is it acceptable that people mess around their GP surgeries, wasting time and money for GPs? If that does not work, perhaps we should put a second penny on income tax, because we need to take tough decisions to make this work.
Another point I want to make comes back to political footballs. Reference has been made to Sussex patient transport, and I chaired the group on that. It was a good example of a cross-party group that with other MPs—including my hon. Friend the Member for Lewes (Maria Caulfield), and the hon. Member for Hove (Peter Kyle) from the Opposition—worked with the CCG to try to find a solution. The reality was that the contract was not stripped out of the public sector. The South East Coast Ambulance Service NHS Foundation Trust refused to carry on the service: it said it was not interested, did not tender and gave it back. There was only one bidder in town—Coperforma. The system did not work well, which is why I was glad that another bidder, not present at the time, eventually came forward. Facts matter!
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
As we have heard, this year marks the 70th anniversary of the creation of our national health service. The NHS is the jewel in our nation’s crown and represents the very best attributes that we as a society hold dear. I truly believe the creation of the NHS, which was born of a yearning desire for things to change following the death and destruction of the second world war, to be the greatest achievement of the Labour party and, indeed, any Government.
It is because both I and my party hold the NHS so dear that Labour Members are concerned by the parlous state in which it finds itself. Pushed to the brink by the biggest financial squeeze in NHS history and reeling from the worst winter crisis on record, the NHS is at breaking point. People are waiting far too long for operations, and performance targets are so far from being met that they are now about as realistic as the Government’s infamous immigration targets.
Official data show that patient waiting times, bed shortages and ambulance queues have hit record levels. The chair of the British Medical Association succinctly summed up the situation when he said:
“the ‘winter crisis’ has truly been replaced by a year-round crisis. Doctors and patients have just endured one of the worst winters on record…We cannot accept that this is the new normal for the NHS.”
Let us be clear that this is not an unavoidable situation or the result of some unforeseen circumstances; the situation has come to pass as a direct result of this Government’s policies. By stark contrast to the policies of the Conservative party, in our 2017 manifesto Labour promised immediate investment in our NHS and, just as importantly, explained how we would pay for it.
The issue of privatisation within the NHS is both an important and an emotive one. I believe in a publicly owned NHS, free at the point of delivery, but the creeping privatisation of services poses a very real threat to that most essential of principles. The figures are irrefutable. Since 2010, NHS expenditure on private health providers has doubled from £4.1 billion in 2009-10 to £9 billion in 2016-17, while the percentage of funding allocated to private sector providers has grown from 4.4% in 2009-10 to 7.7% in 2016-17. Spending on elective treatments outsourced to the private sector rose significantly from £241 million in 2015-16 to £381 million in 2016-17.
Since the Government’s disastrous Health and Social Care Act, one third of contracts have been awarded to private providers, some of which have resulted in failure and the waste of millions of pounds of taxpayers’ money. We have seen the grotesque spectacle of Virgin Care successfully suing our NHS for £1.5 million after losing out on an £82 million contract for children’s health services in Surrey. This has to stop. Labour is committed to reversing privatisation, repealing the Health and Social Care Act and reinstating the powers of the Secretary of State for Health to have overall responsibility for the NHS.
The creation of wholly owned subsidiary companies represents another concern. These new arm’s length private companies appeal to NHS trusts because they can reduce their VAT payments and cut the pay and pensions for any new staff. They result in millions of pounds being wasted on consultancy fees, with the Clatterbridge Cancer Centre in Birkenhead alone spending more than £660,000. That money could have paid for new staff to work in such hospitals.
I am fortunate to have the amazing Queen Elizabeth Hospital in my constituency. Among many other things, it cares for our brave men and women who are injured while serving their country in our armed forces. I want that hospital to continue to flourish and serve the people of Edgbaston and further afield, but I consider privatisation to be a threat to that happening.
Maria Caulfield (Lewes) (Con)
I, too, want to use this opportunity to debunk the myth that the Conservative party wants to, or ever has wanted to, privatise the NHS. That is an image that the Labour party wants to portray, but the facts tell a different story. In the 70 years of the NHS, 43 of those years have been under a Conservative Government, so if privatising the NHS were the sole aim of the Conservative party, it would have been done by now. The NHS remains based on the three founding principles of meeting the needs of everyone, being free at the point of use, and being based on clinical need, not ability to pay. However, facts do not often matter to the Labour party.
I was at a meeting at the weekend of more than 200 GPs who were desperate for the politics to be taken out of the NHS. They welcome the Government’s talk of a long-term settlement and of taking the NHS out of the political cycle. That puts fear into the heart of Labour because it would mean that the NHS would come first, not the motives of the Labour party.
If Labour Members were honest with themselves, they would recall the history of the last Labour Government, who did more for privatisation in the NHS than anyone before or since. In 1999, within two years of coming to power, the Labour Government set up market structures in the NHS to create choice and competition, with hospitals starting to charge by price per episode to compete with the private sector. That is Labour’s record on privatisation in the NHS. In 2003, they set up foundation trusts so that hospitals could be free from the constraints of the NHS and run like a business. That is Labour’s record of privatisation in the NHS. Also in 2003, they introduced independent sector treatment centres—private companies set up to provide wholly NHS elective procedures. That is Labour’s record of privatisation in the NHS.
Some 84% of PFI projects were started under Labour. Although they built £11.8 billion-worth of hospitals, the cost to the NHS is £79 billion over 31 years. In 2009, the Labour Government introduced “any qualified provider”, which we have heard about this afternoon, allowing the private sector to undertake NHS work. That is Labour’s true record of privatising the NHS. The King’s Fund analysis on the Labour Government found that by the time they left office, the NHS in England was operating more like a market, with half of elective patients being offered a choice of the private sector. The culture of the NHS had changed from one of collaboration to one of competition.
I am not against the involvement of the private sector in the NHS. As a research nurse, I worked with many multinational pharma companies setting up joint research studies that gave NHS patients access to drugs long before they were available on the NHS and access to equipment that was paid for by pharma companies and left in perpetuity to the NHS.
Labour Members lecture us on privatisation in the NHS, but the last time they were in government, they wanted to close the Princess Royal in Haywards Heath to patients in my constituency. When we were missing Government targets and breast cancer patients were not getting their treatment under the last Labour Government, did they listen to the breast surgeons in my unit who said, “Give us an extra theatre and we can deliver it.”? No, they spent hundreds of thousands of pounds on performance management consultants, time and motion studies, brainstorming sessions and patient pathway mapping. At the end of that six-month process, they told us that the solution was to have more theatre sessions, which the surgeons had told them in the first place.
This is not just my experience; the British public know that the NHS is safe in Conservative hands. That is why, for 43 of the last 70 years, they have put the Conservative party in charge of the NHS, and long may that continue.
Karen Lee (Lincoln) (Lab)
After eight years of the Government’s austerity agenda, the NHS is on its knees. People in Lincoln commonly wait hours for an ambulance, including those having a heart attack. If a Health Minister happens to be in Lincoln any time soon, they might want to ask about that, because call-to-balloon times for PCI have increased. I am not scaremongering—that is the truth. I am sorry, but I will not pretend that—pardon the pun—everything is rosy.
Although the austerity experiment has been discredited by various economists, we have not seen a halt or a reversal of the underfunding and privatisation of our NHS. With the NHS approaching its 70th birthday, the Government are not providing it with the funding and resourcing it desperately needs. Despite the Government telling us that they are putting record amounts of money into the NHS, compared with countries such as Germany and France, we spend a considerably smaller percentage of our GDP on healthcare.
The latest King’s Fund research confirmed the bleak picture of the policies of the past eight years. The NHS has among the lowest levels of doctors, nurses and beds in the western world. This is not scaremongering; it is the reality of the past eight years’ effect on the health service. I am sorry if people do not like hearing it, but it is the truth. The question should not be why the NHS does not perform better compared with other countries, but rather how the NHS copes under immense pressure when it is so under-resourced. Remember, this is at a time when the Government are prioritising tax cuts for the wealthy and for large corporations.
Deregulation under the Health and Social Care Act 2012 is a stain on this country’s long respect and support for our NHS. There is no role for the private sector if the NHS is fully resourced. Outsourcing has led to nearly two thirds of clinical contracts being won by non-NHS providers. The NHS should not be a cash cow available to the highest bidder. The financial pressures on the NHS have forced some firms to leave the market, while others search for short-term cheap fixes to deliver contracts, which ultimately impacts on patient care.
It is clear that the Government have a not very well hidden agenda: slash, trash and privatise. Underfunding, with little sign of change over the past eight years, only raises the question: do the Government actually want a nationally run service that provides free healthcare to all, free at the point of service? My constituents, after the closure of our walk-in centre—against the wishes of 94% of people who said they wanted it to stay open—are not convinced. The sustainability and transformation partnerships, wholly owned subsidiaries and accountable care organisations are all a ploy for their ideological goal: the backdoor privatisation of our service.
I have seen that at first hand from the hospital floor as a nurse. Instead of just words of praise for those working in the health service—praising nurses sounds really cheap, you know, as if Conservative Members can take some sort of credit for it; it is their hard work, not yours—why not provide them with the resources to do their job properly? Rewards come with actions, not just words.
Kevin Foster (Torbay) (Con)
It is quite interesting to be following the speech we just heard. I will not dwell too much on it, but the hon. Member for Lincoln (Karen Lee) mentioned accountable care organisations. Supposedly, they will have “multiple benefits” and
“contrary to what some of the demonstrators suggest will make it easier for the NHS not to go down the private contracting route”.
Those are not my words, but the words of the right hon. Member for Exeter (Mr Bradshaw), a former Labour Health Minister.
I always welcome the chance to discuss the NHS on the Floor of the House and to consider some of the challenges in my constituency, in particular for social care, given that 9% of the entire population of one of my wards is aged over 85. That brings not only challenges around social care, but questions of how those with chronic conditions are cared for by the NHS.
I had hoped this afternoon’s debate would be constructive. To be fair, the hon. Member for Stockton South (Dr Williams), who is not in the Chamber, gave quite a constructive and thoughtful speech based on his own experience and his time serving on the Health and Social Care Committee. The debate, however, started off with what can best be described as a 40-minute partisan rant. It did include one positive and constructive offer of working with the Government on potential legislation but, other than that, it was quite bizarre to hear the Opposition spokesman running down every private contract given, except for those given by Labour Administrations. We heard an intervention by the leader of Plaid Cymru in Westminster about outsourcing in Wales, which is apparently okay because it is not wholesale, but just bringing in the private sector when it is the right thing to do. The Labour Front-Bench speech was a bizarre spectacle, although not surprising from a Member of the party responsible for 118 out of the 125 NHS PFI contracts.
People think PFI contracts are just about building hospitals, but they are not. I was deputy leader of Coventry City Council when University Hospital opened. The private sector did not just build the hospital; virtually all the facilities and services were privatised as a part of the PFI contract, which raised interesting issues with regard to amending it. Again, the idea that this was some sort of spot purchasing is absolute nonsense. This was a 25-year contract that even included guarantees about income from the car park, which ratcheted up the prices.
It is disappointing that the debate has not been more positive, with a consideration of some issues around health and social care. The other bizarre thing is that I have not yet heard one Labour Member talk about the motion or tell us why giving these papers to the Health and Social Care Committee would make much difference. What do they think the Committee would do with them? The terms of the Humble Address have not been talked about at all. It would be interesting to hear—I will be happy to take an intervention from a shadow Front Bencher—what discussions, if any, there were with the Chair of the Committee, my hon. Friend the Member for Totnes (Dr Wollaston), before the Labour party tabled the motion. It strikes me as bizarre that we have a motion stating that the papers are really crucial and should be given to the Committee, yet no one has talked once about why doing so would be sensible.
I will conclude by talking about the positives in my community. The recent announcement of investment in urgent care services in Torbay has been very welcome, and it will certainly make a difference to patients. This will be the first new A&E department for Torbay since the 1970s. It was also really satisfying this week to see the local trust rated as good in its latest CQC assessment. That is a real tribute to all those who work in the NHS locally, and it deserves to be recognised here in this House.
Karin Smyth (Bristol South) (Lab)
The biggest issue facing the NHS is the money and the workforce, and going into that mix, we have these wholly owned companies. They are a wheeze to gain income, but the consequences are deeply troubling. They drive further fragmentation of the NHS and, when collaboration should be growing, we instead see each trust going its own way.
If these changes for wholly owned companies were driven by service improvement and the appetite of staff for change, the managers and boards of the trusts would be doing their jobs, which is to identify the need for improvement in these services and to speak to their staff about how to achieve it. However, in almost every case, the changes have been progressed in secret, with little or no staff engagement or consultation and with no documents being made public. It is very hard to get the documents from these trusts. Worse still, we are now in an uncontrollable hiving off of NHS assets to these new companies, with no discernible safeguards to prevent the assets, or indeed the whole company, from being sold off to anyone else. They are one step away from being taken outside the NHS to any other provider.
In response to some of my written questions, I have discerned a bit of change in the Government on the NHS. I asked how many trusts have had to change the terms of their authorisation, which was a requirement in the Health and Social Care (Community Health and Standards) Act 2003, to protect the transferred assets. On 11 May, the Government said:
“There is no requirement to change the terms of authorisation when setting up a wholly owned subsidiary and therefore, the Department does not hold the information requested. If trusts hold community interest assets then these are considered public assets and cannot be sold unless subject to a Departmental/Secretary of State approval, however this is only a limited number of assets.
For other assets trusts should consider whether transactions are ‘reportable’ under the transactions guidance and therefore would be subject to a review if above the thresholds outlined.
NHS Improvement has committed to:
The proposed creation of subsidiary companies becoming a reportable transaction to NHS Improvement under the Transactions Guidance, irrespective of size; and”
NHS Improvement will be looking at “subsequent changes”.
While a tick-box exercise and oversight by NHS Improvement is welcome, that is closing the door after the horse has bolted. In answer to another question about continued onward sale, I was told that there would be restrictions where disposal would affect commissioner-requested services. The 2003 Act does not say that. Section 16 talks about NHS foundation trusts not disposing of protected property
“without the approval of the regulator”
and says that protected property is the
“property of the trust designated as protected in its authorisation.”
I think there has been a change in that period and I would like to understand why. If the Minister cannot answer that today, I am happy to write to him.
We have essentially no assurance as to how the transfer of these wholly owned companies to any private bidder, one step on, can be stopped. How would local people ever know? How would the staff now? We cannot get any information from most of these trusts. They are not answering FOI requests and that is why this is essentially of such continued concern.
The first step to remedying this shambles would be to close the VAT loophole, which I do not have time to talk about today. Meanwhile, NHS Improvement should not be encouraging the recreation of a two-tier workforce, especially at a time of such overwhelming concern about the availability of a skilled workforce. This is ever more important with Brexit looming. NHSI is a Government body funded by the taxpayer and accountable through the Secretary of State to Parliament. That it is encouraging and permitting these deals, and doing so in secret, is a disgrace. It should not be allowed. As NHSI is subject to ministerial oversight, the Secretary of State needs to tell it to stop it.
Helen Whately (Faversham and Mid Kent) (Con)
A constituent wrote to me last year to say that, against the backdrop of negativity around healthcare in this country, he personally had had a really good experience of treatment on the NHS at his nearest hospital. It happened to be KIMS Hospital, an independent sector provider, but it had given him what he really wanted: timely, high-quality and caring treatment free at the point he needed it.
The shadow Secretary of State recognised earlier that there was a place for private providers in the NHS. As in the example I have just given, that place might be enabling somebody to get timely treatment at a time of huge pressure on NHS resources, but, from what we have seen, it seems Labour considers the place for private treatment to be whenever Labour is in power. As we heard, in the years running up to 2010, when Labour was in power, there was an increase in the use of private sector providers in the NHS, as I saw when I worked with the NHS, and there was an increase in their use last year in Wales, where Labour is in power.
I do not want to make an ideological argument—I do not particularly want to talk about who provides the care, because what matters to me and my constituents is that they get good care when they need it—but, as Labour is picking this fight, it is only fair to put some truths on the table, and as far as I can see, the place for private providers, from Labour’s point of view, is whenever it is in government.
What matters to me is great care, and I have observed some ways of getting it. In some parts of healthcare, one way is by offering choice. Giving mothers-to-be the choice of where to have their baby makes maternity teams say, “Hold on. We want to be the best place in the area to have a baby.” Choice works, so long as it is accompanied by transparency, and the Government have done much to improve transparency in healthcare, meaning that people can know where to get good treatment and where there are problems, which has driven up quality.
Innovation and new technology can also transform healthcare. Whether the introduction of keyhole surgery, which has hugely shortened stays in hospital, or the exciting things happening with genomics and personalised medicine, innovation is making a huge difference, and it should not matter where that innovation comes from. If it comes from the private sector, we should welcome it. The workforce also matter. We have skilled, capable and committed people providing great care day after day, but I would argue the Government need to place an even greater emphasis on the workforce to make sure that those who work in the NHS or train to be doctors, nurses or other healthcare professionals are valued and nurtured and have rewarding careers that make the most of their talents.
I will conclude with some facts, given the many myths peddled this afternoon: it is clear the NHS is not being privatised—there has been a zero increase in the last year in the use of the independent sector; the NHS is getting more money—£8 billion more this Parliament; and the NHS is treating thousands more people. Times are difficult, but the NHS is rising to the challenge. We should get away from these ideological arguments and put our energies into making sure we have the best possible NHS.
Anneliese Dodds (Oxford East) (Lab/Co-op)
It is a pleasure to follow the hon. Member for Faversham and Mid Kent (Helen Whately). She spoke with characteristic gusto, even if—I am sorry to say it—I did not agree with a single word she said.
I want to underline how privatisation is sapping resources from our NHS, in Oxford East and elsewhere in the country, at the very time it needs them more than ever, because of demographic change and the knock-on impact of cuts elsewhere in our public services. Oxford has particular problems with staff recruitment and retention because of the very high cost of living and the historically high number of EU staff in our local NHS, who are under threat from the Government’s shambolic approach to Brexit. Too few staff for high demand has led to clear reductions—that is right: reductions—in patient care in my local area.
Between January and March this year, 273 non-urgent surgical operations were postponed in my city. Rather than the response being additional resources for the local trust that was working so hard in trying to provide a decent service, in the topsy-turvy world of this Government, my trust lost £1 million because of what happened during that period. Meanwhile, Virgin Care has taken £1.5 million away from our NHS through court action against it. That is an absolute disgrace.
The hon. Member for Cheltenham (Alex Chalk), who, sadly, is no longer in the Chamber, wilfully misconstrued the impact of privatisation. The clue is in the word: it means privatising—making private—something that was public before. We are not talking about the great British biomedical industry, which has always been private. In fact, my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Health Secretary, came to my constituency to see an operation this very week. In fact, the innovation that is promoted by that industry would be aided by an end to inappropriate privatisation. If we stopped sucking out resources and putting them into the pockets of profiteers, they could be spent on the high-quality healthcare and technologies of the future that would actually benefit patients.
The delays in operations in Oxford have become substantially worse over time. Between the end of February 2017 and February 2018, the acute hospital trust had to postpone 952 non-urgent operations; 536 were postponed in the previous year. As the situation has worsened, it has become harder and harder to establish whose responsibility it is. It is no longer the Health Secretary’s responsibility, because, following the Lansley reforms, he has no overall responsibility for the NHS. Oxfordshire’s joint health overview and scrutiny committee, which is meant to oversee services, has just decided to hold many of its meetings in secret, so the public do not even know what is going on at that level.
There are constant arguments about who is responsible for the provision of various essential services. As we all know, breastfeeding support is incredibly important to both babies and mums, but my local clinical commissioning group and my local council cannot agree whose responsibility it is to pay for it, so it is not being delivered properly. That is happening throughout the country. Of course, those services used to be available in children’s centres, but we do not have them any more in Oxfordshire since they were got rid of.
The crisis in Oxford’s NHS has been intensified by all the cuts in social care. Even with all those pressures, however, local NHS staff are working incredibly hard. We are not scaremongering when those staff are coming to our surgeries in tears. When they are telling us how much pressure they are under, it is our duty as parliamentarians to stand up and say “Enough is enough: an end to privatisation and an end to cuts.”
Several hon. Members rose—
Mr Speaker
I am very sorry, but in order to accommodate the remaining speakers—I thought that there were four, but there seem to be five—I must impose a three-minute limit, as I advised the Whip. I want to get everyone in.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to follow my hon. Friend the Member for Oxford East (Anneliese Dodds). I could not agree more with her astute analysis, which also—yet again—applied to what is happening in York.
I want to begin by thanking Pat Crowley, the chief executive of York Teaching Hospital NHS Trust, who has just announced his retirement. He has steered our hospital through unprecedented challenges. I have met the Minister to discuss so many of those challenges—the failed funding formula, the perverse financial incentives, the failed budget integration and the placing of the private profit motive at the heart of our NHS—but I am still waiting for his response to that meeting.
Let me turn to the issue of how money flows. We have talked about private finance in the NHS, but we should also bear in mind that money is not going into primary care and GP services. That is forcing people to use accident and emergency departments, which are the most expensive part of the NHS. Let us follow through the money that people are drawing down. People cannot get in through the front door of the NHS because people are not being cleared out of the back door as a result of the bed-blocking that has resulted from the Government’s cuts in local authority budgets. Those cuts have also caused public health services to be slashed so severely that a massive health crisis is being created. The shocking statistics relating to drug deaths in York are now the worst in the country. We desperately need more resources there. If we invest in people’s health, the health service will save money in the long term. Our teaching hospital is over £20 million in debt—it is the same with the clinical commissioning group—because of the failed funding formula set out under Lansley’s plans for the NHS and the ideology behind that.
I want to take on the argument that the private sector is helping the NHS. The private sector is offloading the low-risk, high-volume work from the NHS—that which under the tariff produces money and profit for the private sector. Formerly that money was invested in the most expensive parts of the NHS to stop the deficits in the NHS; the money went to the ITU, the A&E and the renal units which have a high demand for expensive drugs. The private sector sucking out resources from the NHS in this way is causing the financial failure of the NHS today. Therefore, it is incumbent upon the Minister to withdraw that failed model under the Health and Social Care Act 2012 and to ensure that instead we see real investment in the NHS, which will make a vast improvement to the health service as we move to its 70th anniversary.
Mohammad Yasin (Bedford) (Lab)
I remember when I first heard the term STP; I was portfolio holder for adult services at the time, and while I supported the need for a better integrated health and social care system, there were no details of what this might mean in the future. Within a few months, NHS bosses started talking about accountable care systems and accountable care organisations. Bedford, Luton and Milton Keynes would become a “first wave” accountable care system and this was good, they told us. The decision to become a “first wave ACS” had to be taken within 24 to 48 hours to secure additional funding, so there was no time for consultation with other councillors, let alone the public.
The same approach was taken with the STPs: no or little consultation with a take-it-or-leave-it funding deal, with no time given to us to analyse or debate the pros and cons. Recently we learned that the three CCGs in our STP area have agreed to merge their executive functions, which was “nothing to do with MPs and councillors,” they said, and nothing to do with the public. But they cannot tell us who will be accountable under this new structure, and it is likely that it will not be the people making decisions about our health and social care system.
The term ACO emerged in the US in 2006. ACOs were designed to improve patient experience and control federal expenditure within the US healthcare system, which is dominated by private health and insurance companies. But so far the evidence of the effect of ACOs on quality is not convincing and in fact spending has increased.
There is an inherent risk that if we invite tenders from providers to run health and social care systems across the country, and we do so without proper consultation with patients and service users, we will end up with the sort of mess that we saw at Hinchingbrooke Hospital and hospitals suing the NHS, as Virgin Care did, but on a much larger scale.
The Government’s healthcare reforms of 2012 have created chaos in our health service. We now have a system that allows private providers to escape necessary scrutiny when they get things wrong and to walk away from unprofitable contracts without reproach. Billions of pounds have been wasted that could and should have been invested in frontline care.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I will use this opportunity to focus on continuing the great work of my predecessor the right hon. Alan Johnson and his campaign to ensure that Hull has the much needed child and adolescent mental health unit in our constituency.
We all accept that mental health is a huge problem, and I was proud to play a part in the Education Committee’s joint report on failing a generation, which rightly criticised the Government’s Green Paper on this issue. But we have been waiting for this change for such a long time.
Alan became involved in the campaign for this unit after meeting a young mum and campaigner called Sally Burke. Her daughter, Maisie, had significant mental health problems, so significant that she was sent 140 miles away for treatment. My constituent was not able to see her daughter as much as she would have liked, which highlights the lack of provision in my constituency and the desperate need for it.
The people of Hull came together with the local newspaper, the Hull Daily Mail, and 3,500 people petitioned the Government to say that we desperately need this child and adolescent mental health services unit in our constituency. Members could imagine our joy and celebration when, in September 2017, we were told that the money had been found and that we were going to get the unit we had been desperately waiting and campaigning for.
The trust has got all the planning permissions ready, everything is organised and the land is there, waiting to go. We were told the building would start in October 2017 and that it would be finished and the unit would be opening in October 2018, and finally the people of my constituency would have access to the support they need.
Members could imagine my disappointment when I heard that the trust is unable to draw down the money that has been promised and that there are further delays. I raised this with the Chancellor on 17 April to ask why the money is stuck in the Treasury, and he asked me to write to him. So I wrote to him about it, and then I had to wait for a really long time, until I tabled a written question asking when he would reply to my letter. He eventually replied with the confusing response that the trust needs to submit more information on the business case for the unit. That deeply concerns me because the unit was promised back in September 2017 and we are still waiting.
The people of Kingston upon Hull West and Hessle are not fools, and they will not accept any more delays. They have been campaigning for this unit for years, and I will not let down my predecessor, the wonderful Alan Johnson, by not making sure I deliver on his legacy and getting the CAMHS unit we desperately need. I call on the Minister to take immediate action: stop faffing about and give us the money for our CAMHS unit, which was promised months ago. I promise I will not stop going on about it until he does.
Alex Cunningham (Stockton North) (Lab)
For now, NHS trusts remain the sole shareholder in their wholly owned subsidiary companies—yes, just for now—but those subsidiary companies will be easier to sell in future. The trusts have established those subsidiaries with long contracts under the misguided impression that such contracts protect the trust and the employees. What the trusts do not acknowledge is that the current Government, or a future Government, could order them to sell off a subsidiary company, contracts and all, and, if necessary, could change the law to make it happen.
We have already seen how these new subsidiary companies make their margins off the backs of now former NHS staff who face the prospect of less favourable contracts with no access to the NHS pension scheme, yet some trust executives claim they are transferring employees to protect them. That is absolute rubbish. We all know that when staff are transferred by TUPE, the receiving employer can have a reorganisation. It can create new roles and axe old ones, and it can require people to apply again for what looks like their old job with some subtle changes, with the terms and conditions varied, putting an end to the protections they once enjoyed. This creates the two-tier workforce many others have spoken about today. It means that some people are being treated better than others, with more rights, better pay and better working conditions.
I have even heard that some of these executives believe the changes could be in the best interest of the workforce. None of these executives faces the prospect of being reorganised out of their job or out of their final salary pension scheme with a 15% employer contribution. The executives will continue to get that pension, yet the people they have shifted into new organisations will get a 3% employer contribution to their pension.
In a few years’ time, it will be interesting to see just how many of the original staff are still in these organisations and how many of them are on the same terms and conditions enjoyed by NHS staff who are still employed directly.
I am proud that, just a week ago, one of the teams at the North Tees and Hartlepool NHS Foundation Trust in my Stockton North constituency was shortlisted for the NHS 70th awards, but a few months ago even this trust succumbed to temptation and set up one of these wholly owned subsidiary companies, despite the accounts for an existing subsidiary company showing it needed a bail-out from the trust to survive.
Wholly owned subsidiary companies are not working. They are a mechanism to rid employees of their NHS pension and of collective bargaining. The companies are damaging to employees, and they are damaging to the service in the longer run. What they are really doing is severely damaging the morale of our staff.
Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)
I thank the NHS’s public service workers for all that they do for us. They have stood against cuts under Tory austerity and a decade of SNP cuts in Scotland. Scotland’s NHS workers are underpaid, undervalued and under-resourced while millions of pounds are spent on agency staff. As Richard Leonard, the Scottish Labour leader, said recently, private companies are
“sucking money out of the NHS”,
but Labour in Scotland is ready to stand up to Tory austerity and SNP cuts.
Justin Madders (Ellesmere Port and Neston) (Lab)
This has been an interesting, passionate debate with many knowledgeable contributions. My hon. Friend the Member for Canterbury (Rosie Duffield) raised concerns about a new ALMO in her constituency and the impact on NHS staff working conditions, and I am sure that she will shine a light on that issue relentlessly. Like many Members, my hon. Friend the Member for Blaydon (Liz Twist) mentioned wholly owned subsidiaries, rightly highlighting the fact that the Treasury is turning a blind eye despite the fact that their creation represents a VAT loophole. That tells us everything we need to know about where the Government’s priorities lie. She mentioned NHS staff striking at the Wrightington, Wigan and Leigh NHS Foundation Trust because of their concerns about the impact that subsidiaries will have on their terms and conditions, and Labour Members send our solidarity and support. Government Members need to start listening to the staff.
My hon. Friend the Member for Stockton South (Dr Williams) gave a typically cerebral contribution. He was right that elements of privatisation encourage cherry-picking and a race to the bottom, and I look forward to hearing more from him on that. My hon. Friend the Member for Lincoln (Karen Lee) gave her frontline view of the problems in her constituency, speaking with real passion, and it would be wrong to characterise that first-hand experience as scaremongering. My hon. Friends the Members for Batley and Spen (Tracy Brabin) and for Bristol South (Karin Smyth) mentioned wholly owned companies. Both talked about the secrecy surrounding the plans—and Members sometimes wonder where conspiracy theories come from.
We also heard from my hon. Friends the Members for Kingston upon Hull West and Hessle (Emma Hardy), for York Central (Rachael Maskell), for Oxford East (Anneliese Dodds), for Birmingham, Edgbaston (Preet Kaur Gill), for Oldham East and Saddleworth (Debbie Abrahams), for Stockton North (Alex Cunningham) and for Coatbridge, Chryston and Bellshill (Hugh Gaffney). In fact, we heard from more than 20 Back Benchers today, so I do not have time to refer to every contribution, but some Members seem to have been in denial about the basic facts. Performance targets are being missed month after month, with A&E targets not forecast to be met until next year at the earliest and the 18-week treatment target seemingly dropped altogether. We have among the lowest number per head of doctors, nurses and hospital beds in the western world. We have a recruitment and retention crisis, with more than 100,000 vacancies across the NHS.
The biggest fact of all is that the NHS faces the harshest and most sustained financial squeeze in its 70-year history. Despite the squeeze, the amount of money being directed to the private sector has more than doubled. That is the NHS under the Tories: patients worse off while private companies cash in. We have heard countless examples of what is happening on the ground today and clear evidence about the damage caused by the wasteful, top-down reorganisation of the NHS created by the Health and Social Care Act 2012—damage predicted by just about everyone other than Conservative Members.
Conservative Members have known for years that the 2012 Act is not working, and even the Secretary of State was uncharacteristically coy today when he was given the opportunity to give his own opinion on it. After six years of disaster, we finally hear reports that parts of the Act will be overturned, but there has been no detail of what is proposed. Why are the media being informed of these plans instead of this House? If there is nothing to worry about, why will the Government not come clean? If Ministers are still formulating their proposals, let me offer them some advice: if they propose anything less than a properly funded, comprehensive, reintegrated public NHS that is free at the point of use, we will not support it and the public will not support it, either. If they will not give the NHS the funding it needs and end the toxic privatisation of the health service, we will. I commend the motion to the House.
The Minister for Health (Stephen Barclay)
The Government oppose the motion. There is no complaint from the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston), about papers sought and not provided. Indeed, there are no papers, according to the evidence that the Secretary of State read out at the start of the debate, which was provided to him by officials. There is no logic to the motion when, as several Members pointed out, there has been no increase in the share of NHS spending on the private sector over the past year. As my hon. Friend the Member for Corby (Tom Pursglove) in particular highlighted, the rate of increase has been slower under this Government than it was under previous Governments.
As my hon. Friend the Member for Torbay (Kevin Foster) pointed out, that is perhaps why so few Labour Members wanted to address the motion. As my hon. Friend the Member for Cheltenham (Alex Chalk) said, the motion contradicts both legislation passed by the Labour Government in the form of the Freedom of Information Act, and numerous statements made by senior Labour politicians such as the former Foreign Secretary and Member for Blackburn in his evidence to the Chilcot inquiry.
Instead, there was a mix of confusion and division among Opposition Members. The hon. Member for Lincoln (Karen Lee), who is not in her place and did not stay for the speech of the hon. Member for Bristol South (Karin Smyth), said that there is no logic to the use of the private sector, but in a well-informed and measured speech the hon. Member for Stockton South (Dr Williams) said that sometimes it should be enabled. That point was conceded in the Chamber today by Labour Front Benchers, and in numerous media interviews, including on the “Victoria Derbyshire” show. They seem confused about whether they welcome the use of the private sector.
The confusion extended to the remarks of the hon. Member for Blaydon (Liz Twist). She said that Gateshead trust is very good, yet she seems to ignore the fact that the legislation on subsidiaries was passed under a Labour Government. The staff survey for that trust shows that the subsidiary has a satisfaction rate that is 15% higher than it was in the NHS as a whole. Because of her ideology, she seemed to suggest that her constituents working within that trust, which is 100% owned by the NHS, are wrong.
As my hon. Friends the Members for Lewes (Maria Caulfield) and for Faversham and Mid Kent (Helen Whately) pointed out, there was a rewriting of history. The Labour Government before 2010 embraced the private sector. As illustrated in Wrexham, contracts in Wales are given to the private sector when Labour is in office. Labour Members say one thing in opposition and do something else in office. We have seen the contradiction today. Labour Members say that they dislike accountable care organisations and that they are a form of privatisation. It might surprise colleagues to learn that the Mayor of Greater Manchester, the former Labour Secretary of State for Health, is seeking to pilot an ACO because he recognises the benefits of integration.
The House heard misleading statements today. We were told by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that there has been a slow and steady erosion of the NHS as a provider, even though the facts show a zero increase in the private sector share of NHS spending. My hon. Friend the Member for Bexhill and Battle (Huw Merriman) highlighted the fact that private sector involvement was embraced, sought and progressed by the Blair Government.
That rewriting of history was further underlined by the Labour Members’ PFI amnesia. As my right hon. Friend the Secretary of State pointed out, the NHS has £80 billion of PFI contracts and a £200 billion a year spend on PFI. Labour Members mentioned Carillion—12 of the 13 Carillion contracts for service management were entered into under the Labour Government.[Official Report, 11 June 2018, Vol. 642, c. 4MC.]
The reality is that this Government are investing more in our NHS and delivering more outcomes for patients. Some 2,500 more patients a day are seen within the four-hour A&E target. We are training more dentists. The hon. Members for Lincoln and for Canterbury (Rosie Duffield) failed to mention the extra medical training places offered in their constituencies as part of the Government’s investment.
The Conservatives have run the NHS for the majority of its 70 years. This Government are investing in our NHS and treating more people in it. This Government will ensure that the NHS remains fit for the future.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Main Question put accordingly.