(10 years ago)
Commons ChamberThose examples will alarm people. In Greater Manchester, a bus company has been running ambulance services. We had news this week that an arms manufacturer is bidding for a GP contract. These are the things that are beginning to happen to the NHS. Nobody’s constituents have ever given their permission for any of this to happen.
We heard speeches from the hon. Member for Bosworth (David Tredinnick) and the right hon. Member for Banbury (Sir Tony Baldry), who said that nothing had changed and what was happening in the NHS now was just a continuation of what the previous Government were doing. No, it is not. The right hon. Member for South Cambridgeshire said in a speech on 9 July 2005:
“The time has come for pro-competitive reforms in…health”
and he help up the example of utilities and rail. That was the specific inspiration for his reorganisation. He sold his Bill on the basis that doctors would decide, but doctors tell us that they have no choice but to put services out to the market. Section 75 says that commissioners may not run a tender if there is only one available provider. That is never the case, which is why CCG lawyers conclude that they have no choice but to put services out to tender.
That is why we see, according to figures from the NHS Support Federation, that 865 contracts for NHS services, worth £18.3 billion, have been offered to the market. Some 67% of the contracts awarded so far have gone outside the NHS. It is this decision to mandate the tendering of services which places the NHS in the full glare of EU procurement and competition law. Because Ministers have refused to exempt the NHS from the TTIP treaty, we could soon have private US health care providers ringing up CCGs to challenge them on their commissioning decisions.
This Bill legislates to remove that threat. It repeals section 75 and it really does let doctors and local commissioners decide. It restores the role of the Secretary of State and brings much needed ministerial accountability back to this House. No longer will Ministers be told to write to NHS England when they have concerns. Instead, there will be answers from the Government Dispatch Box about the service that matters most to their constituents. It removes the role of the competition authorities that the Government’s Act introduced. It stops the ludicrous situation where hospitals such as Bournemouth and Poole are not allowed to collaborate. Importantly, it stops hospitals devoting half their beds and half their facilities to the treatment of private patients.
Since Hammersmith and Central Middlesex A and E departments closed two months ago, we have had people waiting in ambulances and waiting rooms with every seat taken. We have even had people waiting on floors. The Government’s answer to that is to close two more A and E departments, those at Charing Cross and Ealing in west London. Is that not just preparing the NHS for failure and for privatisation?
What is happening in west London should send a shiver down the spine of every community in the country. The NHS is being torn apart, which is damaging patient care and leading to the consequences that my hon. Friend outlines.
This is how the character of the NHS is changing under this Government and before our eyes. With every year that the Health and Social Care Act stays on the statute book, the private sector will be more embedded in the NHS and the public NHS weakened as a result. The Government have undermined the “N” in NHS. They are letting our hospitals become part-privatised and they must be stopped. If the Government continue on their current course, in the next Parliament the NHS will be overwhelmed by a toxic mix of cuts and privatisation.
If the Government stop this Bill receiving Royal Assent, it will form the basis of the repeal Bill that the next Labour Government will lay before the House in May next year. But it will do more than that: it will remove the competition role to allow the full integration of health and care to build and lay the foundations for a 21st-century NHS.
One final thing needs to be said. Before we vote, there is a simple truth that all Members in all parts of the House must confront: nobody here has permission from their constituents to put the NHS up for sale. Today is their last chance to put that right before they face their constituents in six months’ time. The people of this country value and trust a public NHS that puts people before profits. This Bill restores that. The party that created the NHS is proud to support it, and I urge all Members to vote for it.
(10 years, 9 months ago)
Commons ChamberMy hon. Friend is absolutely right, and I would love the Government to explain that everything is fine and that there is no problem at all to more than 100,000 people who have waited more than four hours on a trolley this year, or almost 1 million people who have waited more than four hours in A and E. The complacency is not justified, and if those people were to read the Government’s motion, I am afraid, quite frankly, they would be astonished.
Perhaps I may help my right hon. Friend by saying that the campaign in North Norfolk began on the Minister’s website after the excellent campaign run by the Labour prospective parliamentary candidate, Denise Burke, who pointed out how deficient local services were—[Interruption.]
Will my right hon. Friend join me in condemning the Government for still classing A and Es as such when, like the one at Charing Cross, they are in practice closing and turning into GP-run clinics? The Government are still calling them A and Es, and people are misled. That will lead them to go to the GP-run centres when they should be going to properly staffed A and Es, and we will get tragedies such as the one at Chase Farm.
I am afraid that under the coalition, NHS treatment for “Gove-itis” is being rationed, like everything else, unfortunately. As my hon. Friend said, the Government claim they are keeping A and Es and call them “local” A and Es, but they are actually downgrading A and E units all over the country. How can it make sense to close and downgrade A and Es in the midst of an A and E crisis? In west London, as my hon. Friend knows, incredible changes are being introduced without proper regard for the evidence I am presenting to the House today of a change in A and E and of sustained pressure on A and E units. The Government must go back and consider their plans for my hon. Friend’s constituency and the rest of London.
(10 years, 11 months ago)
Commons ChamberThe Secretary of State may remember that when he came into government he stood on a manifesto promising real-terms increases. He and the Prime Minister have stood at the Dispatch Box every week since the election saying that I said that we would cut the NHS, but that is not the case: I stood on a manifesto promising protection for the NHS in real terms. I said that if there were to be real-terms increases they should be given to social care instead, because it would be “irresponsible”—that was the quote—if the Government overfunded the NHS only to let social care services collapse: it would be a false economy, because it would push more and more older people into hospitals, and hospitals would stop functioning.
Do you know what? That is happening right now. The Secretary of State’s cuts to social care are forcing more and more older people into hospital. That is why he has an A and E crisis—because hospitals are full. On his watch there has been a 66% increase in people aged over 90 going into A and E via blue-light ambulances. If he is proud of that, that is up to him, but I certainly would not be.
I am not surprised that the Secretary of State wants to change the subject, because if that decision is confirmed tomorrow my clinical commissioning group will lose £29 million—13% of its budget for hospital care. It has some of the poorest health outcomes, but that money will go to places where life expectancy and health outcomes are much better—in other words, Tory-controlled areas. That is a disgrace, coming on top of the closure of fine hospitals such as Charing Cross and emergency hospitals. That is the truth about what this Secretary of State is doing and I am afraid that all we have heard today is political spin.
The Secretary of State began by quoting the principles of the NHS. I was always led to believe that one of the principles is that the NHS should respect need—that funds should follow those in greatest need. [Interruption.] The Secretary of State says, “Absolutely.” In constituencies in parts of London, the midlands, the north-west, Yorkshire and the north-east, male life expectancy is 10 years lower than in other parts of the county. There is real need in those communities, but they will be the biggest losers if the change goes ahead. I believe that it is immoral to take money out of those communities to hand it to areas where life expectancy is already longer.
I hope that NHS England is listening to this debate. Quite apart from the morality of whether the change should be made, how is it that a quango can distribute about £80 billion of public money to our constituencies while we seemingly have no locus whatever in such a decision? Should not the Secretary of State be at the Dispatch Box either to defend changes that he makes or to say that such changes will not go ahead, so being accountable to this House? Instead, a quango—the biggest in the world—seems to be about to take money out of some of the most deprived parts of the country.
(11 years, 5 months ago)
Commons ChamberI entirely agree, and I shall say more about that issue shortly.
Let me return to the subject of the 111 service. Will the Secretary of State review the contracts with the aim of negotiating changes so that more calls can be handled by nurses? The use of the computer algorithm should be reviewed as a matter of urgency, and the full roll-out of 111 should be delayed until the problems have been solved.
There are more general questions to be asked about the scale and pace of NHS privatisation. NHS Direct offers an illustration of what happens when services are broken up. Those who attended last week’s summit heard that in some areas there had been a huge increase in the provision of 999 ambulances by private companies. It was said that on a single day in Yorkshire, 50% of 999 calls had been responded to by private operators. I think that the public would be surprised to know that. It shows that there is no part of our NHS that cannot be put up for sale by this Government.
Is the Secretary of State satisfied that those private crews are appropriately trained and have the right equipment? Is there not a danger that because contractors are operating in isolation from the rest of the system, they will all too often simply transport people to A and E? Does the Secretary of State envisage any limits to private 999 services? Given that the issue raises fundamental questions about emergency services, should there not be a debate about it before this goes any further?
Fourthly—I come now to the point raised by my hon. Friend the Member for Harrow West (Mr Thomas)—there is good evidence to show that NHS walk-in centres have diverted pressure from A and E units. In 2010-11, there were about 2.5 million visits to such centres from people who might otherwise have gone to A and E. Analysis by the House of Commons Library shows that 26 of them closed in the last year alone, and that the number is down by a quarter. The Government have let that happen, but at least Monitor has intervened and set up a review of the loss of walk-in centres. Will the Secretary of State halt all further closures while the review is taking place?
That brings me to my fifth and final point, which concerns A and E closures and downgrades. At least 25 A and E units—one in 10—are under threat or have recently closed. The trouble with these plans is that they were drawn up in a different context, when A and E was not under the pressure that it is under today. Let me say this to the Secretary of State: if a clinical case can be made in support of closures—if there is evidence that lives can be saved—the Opposition will not oppose the plans. However, we cannot accept the pushing through of proposals that have not taken enough account of the latest evidence, and cannot show that extra pressure can be safely absorbed by neighbouring units. That is important, because the public will rightly ask this simple question: how can it make sense to close A and Es in the middle of an A and E crisis? To reassure people, will the Secretary of State personally review all the ongoing A and E closure or downgrade proposals on a case-by-case basis, in the light of the very latest evidence of pressure in the local health economy?
I will give way one last time to each of my hon. Friends, but then I must finish my speech.
What my right hon. Friend has been saying will be music to the ears of people in west London, where four A and E units are slated for closure. All of them are coping with dreadful circumstances. Will my right hon. Friend—and perhaps also the hon. Member for Enfield North (Nick de Bois), who seems to share his view—have a word with my local Conservatives, who are supporting all those closures?
I think that everyone needs to consider their position in the light of the evidence that is emerging about pressure on A and E, particularly in London. I pay tribute to the excellent and determined campaign run by my hon. Friend, and I noted what was said yesterday by the hon. Member for Enfield North. Perhaps one of the consequences of today’s debate will be agreement across the Floor of the House to delay any closures pending a personal review of the evidence by the Secretary of State.
(12 years, 4 months ago)
Commons ChamberI am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.
As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.
We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”
We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.
On the subject of brutal closures, did my right hon. Friend have a chance to look at the authoritative report by David Rose in The Mail On Sunday yesterday about the “Beeching-style” closure of major casualty units? Four out of nine of the units to be closed are in west London, leaving my constituents and 2 million people in west London without adequate health cover.
I have no idea how Ministers expect west London to cope with service reductions on that scale, nor do I know how they square them with the moratorium on hospital closures and changes which they promised at the last election. Perhaps we will hear some justification later today, although I will turn to reconfigurations shortly.
(13 years, 9 months ago)
Commons ChamberMy hon. Friend, who knows more about these matters than anyone in the House, has put the Secretary of State straight.
I have one final comment about parents. We support the extension of free early years provision for disadvantaged two-year-olds, but we are deeply concerned that that is undermined by the Government’s failure to protect Sure Start. Furthermore, giving the Secretary of State the power to define early years provision, who gets it and when they get it places question marks over the universal free entitlement for three and four-year olds. I ask him to make it clear that he does not intend to cut such provision or to introduce means-testing, particularly as fears have also been raised by the Bill’s introduction of powers to charge.
One of the Secretary of State’s homilies was on equal chances, but my constituency is one of the most socially and ethnically diverse in the country, and more than half the Sure Start centres are being closed by a Conservative council. The Secretary of State and his Ministers wash their hands of that, but is it not perverse to talk about creating extra provision for two-year-olds when the provision for three and four-year-olds is being cut by 50% in seats such as mine?
The Government say that they have given councils enough money, but they have also given them a list of 20 or more things that they have to fund from the same budget as that which pays for Sure Start. How does my local authority, which is getting a cut of some £160 per head from the Government, keep all its support and provision open while other councils in other parts of the country get cuts on nothing like that scale? It is deeply unfair, and it will take away crucial services in constituencies such as my hon. Friend’s and mine.
(13 years, 10 months ago)
Commons ChamberWe will leave those kinds of points to Back Benchers; we do not expect them from the Chair of the Select Committee.
The fundamental point that the Government are missing is that participation is only part—[Interruption.] The hon. Member for Stroud (Neil Carmichael) does not have to put his hand up—he can just stand up. Participation is only part of the story; EMA helps students to succeed once they arrive at college. It stands to reason that young people do better if they can afford the books or equipment that support the course. As many young people have told me, EMA means that they do not have to take a part-time job, so they can focus all their energy and attention on their studies. College after college reports that EMA improves attendance, helps people to stay the course, reduces the drop-out rate and, in the end, brings a higher rate of achievement.
The infamous Cameron Direct meeting that has been raised took place in Hammersmith on 6 January last year. Sadly, I was not at the meeting because I was handing out leaflets outside, but this morning I spoke to the person who asked the relevant question. The Prime Minister said:
“We’ve looked at Educational Maintenance Allowances…no we don’t have any plans to get rid of them.”
Where does my right hon. Friend think the Government now stand with their credibility on this issue?
(14 years ago)
Commons ChamberI am now going to wind up my remarks. Some of the hon. Gentleman’s colleagues will be happy about that, even if he is not.
The Government’s policy is an ideological gamble. Schools will be able to use money to employ whomsoever they like, even if that person has no qualifications, in any premises, which, as we have heard, might include converted prisons, bingo halls, hairdressers and pet shops.
What guarantees do parents have that the Secretary of State’s free schools will have the highest standards? What guarantees do they have that they can hold those schools to account if they do not meet such standards? The truth is that free schools are a risky ideological experiment being pushed through at speed with a lack of reliable evidence. Is not there a real danger that one person’s decision to create a free school will undermine existing good provision in an area and a school’s ability to improve?
Should not access to safe outdoor space and sports facilities be a right for every single child?
My right hon. Friend will know that I have the misfortune that the local authority in my area is one of the ideological dustbins of the Conservative party. It adopts all these initiatives, so we have three of the 16 new free schools, but there are no suitable sites for them. Existing community organisations are being evicted from their premises so that a few free schools can take them over, despite the fact that their catchment areas are outside the borough and the area. How is that localism or parent choice? Is it not the triumph of ideology over education standards?